Healthcare Provider Details

I. General information

NPI: 1952461360
Provider Name (Legal Business Name): NELSON CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 WHITE HORSE PIKE STE 201
ATCO NJ
08004-2257
US

IV. Provider business mailing address

289 WHITE HORSE PIKE STE 201
ATCO NJ
08004-2257
US

V. Phone/Fax

Practice location:
  • Phone: 856-767-8800
  • Fax: 856-767-8056
Mailing address:
  • Phone: 856-767-8800
  • Fax: 856-767-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00520400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00520400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00520400
License Number StateNJ

VIII. Authorized Official

Name: DR. ERIC ALLEN NELSON
Title or Position: CO-OWNER
Credential: DC
Phone: 856-767-8800