Provider Demographics
NPI:1891510079
Name:NELSON, JACOB RILEY MAURICIO (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RILEY MAURICIO
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 1:4330 CZECH LN NE STE A6
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2334
Mailing Address - Country:US
Mailing Address - Phone:319-550-7054
Mailing Address - Fax:
Practice Address - Street 1:4330 CZECH LN NE STE A6
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2334
Practice Address - Country:US
Practice Address - Phone:319-550-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor