Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 21451 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 2714 | OR |
NPI | 1265577217 |
---|---|
Provider Name | Dr. Wayne R Nelson |
First Address | Klamath Falls, OR 97601-5947 |
Second Address | Klamath Falls, OR 97601-5947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 11/02/2014 |