Provider Demographics
NPI:1861875700
Name:NELSON, MICHAEL (DC, ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MILLS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4070
Mailing Address - Country:US
Mailing Address - Phone:864-881-2242
Mailing Address - Fax:
Practice Address - Street 1:16 MILLS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4070
Practice Address - Country:US
Practice Address - Phone:864-881-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor