Provider Demographics
NPI:1568118909
Name:NILSSEN, ELLIOTT (DC)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:NILSSEN
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 1:319 NW MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1903
Mailing Address - Country:US
Mailing Address - Phone:812-423-9146
Mailing Address - Fax:775-766-6516
Practice Address - Street 1:319 NW MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1903
Practice Address - Country:US
Practice Address - Phone:812-423-9146
Practice Address - Fax:775-766-6516
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003413A111N00000X
WACH61266571111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician