MEDICARE: DR. MICHAEL RICHARD NIELSEN 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	529	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27285	OTHER	NE	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1932134715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD NIELSEN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 567
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-0567
Country	:	US
Telephone Number	:	308-345-2995
Fax Number	:	308-345-2996

Provider Business Practice Location Address
First Line	:	114 W C ST
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-3612
Country	:	US
Telephone Number	:	308-345-2995
Fax Number	:	308-345-2996

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/18/2010

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