MEDICARE: DR. DOUGLAS L. NELSON D.C.

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	DC5180	TX

General Provider Information

NPI Number	:	1740261056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS L. NELSON D.C.

Provider Business Mailing Address
First Line	:	2721 NALL ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5203
Country	:	US
Telephone Number	:	409-727-1609
Fax Number	:	409-727-2920

Provider Business Practice Location Address
First Line	:	2721 NALL ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5203
Country	:	US
Telephone Number	:	409-727-1609
Fax Number	:	409-727-2920

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	01/19/2010

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