Provider Demographics
NPI:1588733646
Name:NELSON, JULIE BETH (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:BETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5517
Mailing Address - Country:US
Mailing Address - Phone:703-319-1100
Mailing Address - Fax:703-938-0694
Practice Address - Street 1:2557 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-5517
Practice Address - Country:US
Practice Address - Phone:703-319-1100
Practice Address - Fax:703-938-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU70986Medicare UPIN
VA490106Medicare PIN