Provider Demographics
NPI:1184785156
Name:NIELSEN, RYAN MICHIAL (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHIAL
Last Name:NIELSEN
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 1:309 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2317
Mailing Address - Country:US
Mailing Address - Phone:252-792-9956
Mailing Address - Fax:252-799-0040
Practice Address - Street 1:309 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2317
Practice Address - Country:US
Practice Address - Phone:252-792-9956
Practice Address - Fax:252-799-0040
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456004AMedicare UPIN