Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIA-415 | ID |
NPI | 1770681231 |
---|---|
Provider Name | Dr. Scott Dee Nelson |
First Address | Blackfoot, ID 83221-2224 |
Second Address | Blackfoot, ID 83221-2224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |