Provider Demographics
NPI:1528090222
Name:NELSON, JAMES H (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
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 1:515 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5274
Mailing Address - Country:US
Mailing Address - Phone:320-235-2720
Mailing Address - Fax:320-235-2220
Practice Address - Street 1:515 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5274
Practice Address - Country:US
Practice Address - Phone:320-235-2720
Practice Address - Fax:320-235-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN407027500Medicaid
MNT65912Medicare UPIN
MN407027500Medicaid