Healthcare Provider Details

I. General information

NPI: 1467736231
Provider Name (Legal Business Name): NIELSON FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 W 36TH ST STE 100
ST LOUIS PARK MN
55416-5470
US

IV. Provider business mailing address

5050 W 36TH ST STE 100
ST LOUIS PARK MN
55416-5470
US

V. Phone/Fax

Practice location:
  • Phone: 952-925-4085
  • Fax: 952-925-1394
Mailing address:
  • Phone: 952-925-4085
  • Fax: 952-925-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY JAY NIELSON
Title or Position: CEO
Credential: D.C.
Phone: 952-925-4085