Healthcare Provider Details

I. General information

NPI: 1467786871
Provider Name (Legal Business Name): JEFFREY RYAN NELSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 205
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

1170 PARADISE SAFARI DR
HENDERSON NV
89002-8936
US

V. Phone/Fax

Practice location:
  • Phone: 702-479-2500
  • Fax: 702-990-7711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01361
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: