Provider Demographics
NPI:1528120920
Name:NELSEN CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:NELSEN CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NELS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-736-9222
Mailing Address - Street 1:1006 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3808
Mailing Address - Country:US
Mailing Address - Phone:919-736-9222
Mailing Address - Fax:919-736-9005
Practice Address - Street 1:1006 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3808
Practice Address - Country:US
Practice Address - Phone:919-736-9222
Practice Address - Fax:919-736-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1895111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085WFOtherBCBS
NC8908661Medicaid
NC8908661Medicaid
NC085WFOtherBCBS