Healthcare Provider Details

I. General information

NPI: 1164087052
Provider Name (Legal Business Name): ZACHARY DAVID NELSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACHARY DAVID NELSON ZACHARY NELSON DC

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11279 TALLMADGE WOODS DR NW
GRAND RAPIDS MI
49534-6318
US

IV. Provider business mailing address

11279 TALLMADGE WOODS DR NW
GRAND RAPIDS MI
49534-6318
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-9702
  • Fax: 616-791-4661
Mailing address:
  • Phone: 616-791-9702
  • Fax: 616-791-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: