Provider Demographics
NPI:1962575308
Name:CHELLEN, NELS HUNTER (DC)
Entity type:Individual
Prefix:
First Name:NELS
Middle Name:HUNTER
Last Name:CHELLEN
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 1:4144 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1727
Mailing Address - Country:US
Mailing Address - Phone:952-474-1777
Mailing Address - Fax:
Practice Address - Street 1:4144 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1727
Practice Address - Country:US
Practice Address - Phone:952-474-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07597CHOtherBCBS
MN705232400Medicaid
MN350002732Medicare ID - Type Unspecified
MN705232400Medicaid