MEDICARE: DR. DUSTY L NIELSEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3860	OK

General Provider Information

NPI Number	:	1184801623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTY L NIELSEN D.C.

Provider Business Mailing Address
First Line	:	1502 OKLAHOMA AVE
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-4357
Country	:	US
Telephone Number	:	580-256-3122
Fax Number	:	580-254-3839

Provider Business Practice Location Address
First Line	:	1502 OKLAHOMA AVE
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-4357
Country	:	US
Telephone Number	:	580-256-3122
Fax Number	:	580-254-3839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	06/03/2013

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