MEDICARE: DR. LARRY D NELSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath		ID
2	111N00000X	Chiropractor	CHIA631	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C9453	OTHER	ID	BLUE CROSS
2	000010020547	OTHER	ID	BLUE SHIELD
3	350035586	OTHER	ID	PALMETTO RAILROAD

General Provider Information

NPI Number	:	1518986264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY D NELSON DC

Provider Business Mailing Address
First Line	:	2585 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7516
Country	:	US
Telephone Number	:	208-522-0200
Fax Number	:	208-523-6051

Provider Business Practice Location Address
First Line	:	2585 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7516
Country	:	US
Telephone Number	:	208-522-0200
Fax Number	:	208-523-6051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/31/2024

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Directions to “ DR. LARRY D NELSON DC” Practice Location

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