Provider Demographics
NPI:1871641258
Name:NELSON, GREGORY MORGAN (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MORGAN
Last Name:NELSON
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 1:1007 HARBOR HILLS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8859
Mailing Address - Country:US
Mailing Address - Phone:906-225-0597
Mailing Address - Fax:906-225-9281
Practice Address - Street 1:1007 HARBOR HILLS DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8859
Practice Address - Country:US
Practice Address - Phone:906-225-0597
Practice Address - Fax:906-225-9281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E21073OtherBCBSMI
MI0E250220952Medicare ID - Type Unspecified