MEDICARE: MICHAEL NELSON DC

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	5818	OR

General Provider Information

NPI Number	:	1275060410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NELSON DC

Provider Business Mailing Address
First Line	:	PO BOX 1235
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-8135
Country	:	US
Telephone Number	:	503-357-2187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 NW HIGHWAY 101
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-4254
Country	:	US
Telephone Number	:	541-961-8116
Fax Number	:

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	03/29/2019

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