Provider Demographics
NPI:1154009165
Name:NELSON, PEYTON JOHN CURTIS
Entity type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:JOHN CURTIS
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PEYTON
Other - Middle Name:JOHN CURTIS
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2595 N MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4224
Mailing Address - Country:US
Mailing Address - Phone:318-443-1313
Mailing Address - Fax:318-443-1366
Practice Address - Street 1:2595 N MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4224
Practice Address - Country:US
Practice Address - Phone:318-443-1313
Practice Address - Fax:318-443-1366
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty