Provider Demographics
NPI:1124076229
Name:NELSON, BRYAN C (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:C
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 OGDEN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1794
Mailing Address - Country:US
Mailing Address - Phone:606-679-1529
Mailing Address - Fax:606-679-1529
Practice Address - Street 1:430 OGDEN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1794
Practice Address - Country:US
Practice Address - Phone:606-679-1529
Practice Address - Fax:606-679-1529
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10805243OtherCAQH
KY000000047693OtherANTHEM BC & BS
KY617889OtherACN GROUP
KY10805243OtherCAQH
KY6056901Medicare ID - Type Unspecified