Healthcare Provider Details

I. General information

NPI: 1215393079
Provider Name (Legal Business Name): SAMUEL LIONEL NELSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6885 TUTT BLVD STE 100
COLORADO SPRINGS CO
80923-3688
US

IV. Provider business mailing address

10126 ANGELES RD
PEYTON CO
80831-8483
US

V. Phone/Fax

Practice location:
  • Phone: 719-922-2207
  • Fax:
Mailing address:
  • Phone: 719-922-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR0008620
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: