Provider Demographics
NPI:1366581621
Name:NELSON, WILLIAM L (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:516 N DIAMOND BAR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1056
Mailing Address - Country:US
Mailing Address - Phone:909-860-1301
Mailing Address - Fax:909-860-1330
Practice Address - Street 1:516 N DIAMOND BAR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1056
Practice Address - Country:US
Practice Address - Phone:909-860-1301
Practice Address - Fax:909-860-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21597AMedicare PIN