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General NPI Number Information
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NPI Number | 1194136747
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Entity Type | Organization
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Legal Business Name | NELSON CHIROPRACTIC WELLNESS CENTER INC.
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 6500 67TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-1403
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Country | US
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Telephone | 815-322-6046
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Fax |
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Provider Business Mailing Address
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Address Line | 525 AUTUMN BLVD APT 303
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City | LAKEMOOR
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State | IL
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Zip | 60051-6690
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Country | US
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Telephone | 815-322-6046
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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. PASCALE NELSON
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Credential | D.C.
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Telephone | 815-322-6046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 501712
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License Number State | WI
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