Provider Demographics
NPI:1528255973
Name:WELLNESS 1ST OF AUSTIN INC
Entity type:Organization
Organization Name:WELLNESS 1ST OF AUSTIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NESVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-437-7781
Mailing Address - Street 1:300 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912
Mailing Address - Country:US
Mailing Address - Phone:507-437-7781
Mailing Address - Fax:507-437-2937
Practice Address - Street 1:300 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-437-7781
Practice Address - Fax:507-437-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00236504OtherRAILROAD
MN819637100Medicaid
MN906S3WEOtherBCBS
C03723Medicare PIN