Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 5066 | MN |
NPI | 1457683773 |
---|---|
Provider Name | Dr. Mark Daniel Nelson |
First Address | Cedar, MN 55011-0036 |
Second Address | Cedar, MN 55011-4425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2010 |
Last Update Date | 11/02/2010 |