MEDICARE: CHAD R. 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	111N00000X	Chiropractor	DC26108	CA

General Provider Information

NPI Number	:	1548201668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD R. NELSON DC

Provider Business Mailing Address
First Line	:	1931 BASIL DR
Second Line	:
City	:	MANTECA
State	:	CA
Zip	:	95336-8538
Country	:	US
Telephone Number	:	209-824-8715
Fax Number	:

Provider Business Practice Location Address
First Line	:	4475 1ST ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94551-4915
Country	:	US
Telephone Number	:	925-449-3356
Fax Number	:	925-449-5229

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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Directions to “ CHAD R. NELSON DC” Practice Location

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