1477566404 NPI number — NELSON CHIROPRACTIC SYSTEMS, P.C.

Table of content: (NPI 1477566404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477566404 NPI number — NELSON CHIROPRACTIC SYSTEMS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELSON CHIROPRACTIC SYSTEMS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477566404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2377 CUMBERLAND SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-359-9541
Provider Business Mailing Address Fax Number:
563-344-3914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2377 CUMBERLAND SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-359-9541
Provider Business Practice Location Address Fax Number:
563-344-3914
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
563-359-9541

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  06715 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0201796 DR. FRIEMEL , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0202619 DR. GALL , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174788442 . This is a "NPI - DR. GALL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 48886 . This is a "WELLMARK - DR. TRACI NELS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1186874 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205891868 . This is a "NPI - DR. TRACI NELSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174788442 . This is a "WELLMARK - DR. GALL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1871777474 . This is a "NPI - DR. FRIEMEL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 72004 . This is a "WELLMARK DR. FRIEMEL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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