Provider Demographics
NPI:1194745224
Name:NELSON, DAN L (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:L
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 1:16561 BOLSA CHICA ST
Mailing Address - Street 2:201
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3594
Mailing Address - Country:US
Mailing Address - Phone:714-377-1052
Mailing Address - Fax:714-377-1073
Practice Address - Street 1:16561 BOLSA CHICA ST
Practice Address - Street 2:201
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3594
Practice Address - Country:US
Practice Address - Phone:714-377-1052
Practice Address - Fax:714-377-1073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28705Medicare ID - Type Unspecified