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General NPI Number Information
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NPI Number | 1154590016
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Entity Type | Organization
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Legal Business Name | DUSTY NIELSEN, D.C. P.L.L.C.
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1502 OKLAHOMA AVE
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City | WOODWARD
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State | OK
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Zip | 73801-4357
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Country | US
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Telephone | 580-256-3122
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Fax | 580-254-3839
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Provider Business Mailing Address
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Address Line | 1502 OKLAHOMA AVE
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City | WOODWARD
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State | OK
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Zip | 73801-4357
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Country | US
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Telephone | 580-256-3122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUSTY L NIELSEN
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Credential | D.C.
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Telephone | 580-256-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 3860
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License Number State | OK
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