Healthcare Provider Details

I. General information

NPI: 1639030224
Provider Name (Legal Business Name): THE HEALTHY PLACE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 JUNCTION RD STE C
MADISON WI
53717-2151
US

IV. Provider business mailing address

515 JUNCTION RD STE C
MADISON WI
53717-2151
US

V. Phone/Fax

Practice location:
  • Phone: 608-467-8116
  • Fax: 608-291-9190
Mailing address:
  • Phone: 608-467-8116
  • Fax: 608-291-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NELSON
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 608-467-8116