Provider Demographics
NPI:1174597272
Name:NELSON, WILLIAM J (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 E INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0551
Mailing Address - Country:US
Mailing Address - Phone:701-222-8322
Mailing Address - Fax:701-222-8397
Practice Address - Street 1:1051 E INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0551
Practice Address - Country:US
Practice Address - Phone:701-222-8322
Practice Address - Fax:701-222-8397
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12218Medicaid
ND911797972OtherTAX ID NUMBER
NDU94054Medicare UPIN
ND911797972OtherTAX ID NUMBER