MEDICARE: DR. NATHAN MICHAEL CORNELIUS 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	5760	MN

General Provider Information

NPI Number	:	1518207133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN MICHAEL CORNELIUS D.C.

Provider Business Mailing Address
First Line	:	2421 HANLEY RD
Second Line	:	STE 800
City	:	HUDSON
State	:	WI
Zip	:	54016-8400
Country	:	US
Telephone Number	:	715-386-4075
Fax Number	:	715-386-4069

Provider Business Practice Location Address
First Line	:	1965 CLIFF LAKE RD STE 103
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2591
Country	:	US
Telephone Number	:	651-340-2609
Fax Number	:

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

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	05/05/2016

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