Provider Demographics
NPI:1699815647
Name:NELSON, LAWRENCE KARL (DC,DACNB)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:KARL
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC,DACNB
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:K
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC,
Mailing Address - Street 1:PO BOX 2415
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-2415
Mailing Address - Country:US
Mailing Address - Phone:503-855-4465
Mailing Address - Fax:888-201-5353
Practice Address - Street 1:7100 SW HAMPTON ST
Practice Address - Street 2:STE 121A
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8390
Practice Address - Country:US
Practice Address - Phone:503-855-4465
Practice Address - Fax:888-201-5353
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1695111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology