MEDICARE: DR. JOSHUA 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	X012914-1	NY

General Provider Information

NPI Number	:	1790223832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA NELSON D.C.

Provider Business Mailing Address
First Line	:	895 PARKSIDE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-2036
Country	:	US
Telephone Number	:	716-490-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD # A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-490-0210
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	05/14/2019

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