Healthcare Provider Details

I. General information

NPI: 1023781770
Provider Name (Legal Business Name): J NELSON CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/06/2023
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 FLETCHER PKWY
LA MESA CA
91942-3005
US

IV. Provider business mailing address

8491 FLETCHER PKWY
LA MESA CA
91942-3005
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-0733
  • Fax: 619-828-6558
Mailing address:
  • Phone: 619-333-0733
  • Fax: 619-828-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER NELSON
Title or Position: OWNER/PROVIDER
Credential: DC
Phone: 619-333-0733