MEDICARE: DR. MICHAEL D 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	038009841	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982697983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D NELSON DC

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-0215
Country	:	US
Telephone Number	:	815-732-2826
Fax Number	:	815-732-7617

Provider Business Practice Location Address
First Line	:	1307 W WASHINGTON ST
Second Line	:	SUITE 115
City	:	OREGON
State	:	IL
Zip	:	61061-1022
Country	:	US
Telephone Number	:	815-732-2826
Fax Number	:	815-732-7617

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/21/2010

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Directions to “ DR. MICHAEL D NELSON DC” Practice Location

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