Healthcare Provider Details

I. General information

NPI: 1528120920
Provider Name (Legal Business Name): NELSEN CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E ASH ST
GOLDSBORO NC
27530-3808
US

IV. Provider business mailing address

1006 E ASH ST
GOLDSBORO NC
27530-3808
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-9222
  • Fax: 919-736-9005
Mailing address:
  • Phone: 919-736-9222
  • Fax: 919-736-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1895
License Number StateNC

VIII. Authorized Official

Name: DR. NELS D NELSEN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 919-736-9222