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General NPI Number Information
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NPI Number | 1578824678
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Entity Type | Organization
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Legal Business Name | NELSON CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 4234 E WESTERN DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-5828
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Country | US
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Telephone | 928-646-7228
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Fax | 928-634-7288
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Provider Business Mailing Address
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Address Line | 4234 E WESTERN DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-5828
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Country | US
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Telephone | 928-646-7228
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Fax | 928-634-7288
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON DANIEL NELSON
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Credential | D.C.
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Telephone | 928-646-7228
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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 | 5583
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License Number State | AZ
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