Healthcare Provider Details

I. General information

NPI: 1356675896
Provider Name (Legal Business Name): CHRIS J NELSON ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 HUDSON ROAD
CEDAR FALLS IA
50613
US

IV. Provider business mailing address

112 6TH ST SW APT 2
WAVERLY IA
50677-3041
US

V. Phone/Fax

Practice location:
  • Phone: 402-250-7743
  • Fax:
Mailing address:
  • Phone: 402-250-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000716
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: