Provider Demographics
NPI:1992788517
Name:NELSON, RICHARD CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CURTIS
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 1:4509 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4551
Mailing Address - Country:US
Mailing Address - Phone:309-797-3182
Mailing Address - Fax:309-757-8799
Practice Address - Street 1:4509 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4551
Practice Address - Country:US
Practice Address - Phone:309-797-3182
Practice Address - Fax:309-757-8799
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-008754OtherLICENSE #
IL36-4284103OtherTAX ID #
IL539960Medicare ID - Type Unspecified
ILU74678Medicare UPIN