Provider Demographics
NPI:1447260567
Name:NESSETH, DAVID GENE (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GENE
Last Name:NESSETH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-0818
Mailing Address - Country:US
Mailing Address - Phone:320-286-6336
Mailing Address - Fax:320-286-6337
Practice Address - Street 1:235 BROADWAY AVE SOUTH
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321
Practice Address - Country:US
Practice Address - Phone:320-286-6336
Practice Address - Fax:320-286-6337
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN199G0NEOtherBCBS
0151215003OtherPRIME WEST
MN218659400Medicaid
MN4451330OtherMEDICA
112257OtherHEALTH PARTNERS