Jeremy John Nelson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5635 Issued in MN

Practice address

104 Park Ave N
Suite 101
Park Rapids, MN 56470-1598

Phone

(218) 366-2174

Fax

(218) 366-2175

NPI assigned

Dec 9, 2011

Last updated

Dec 7, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2011

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Performance Chiropractic, PLC

  • Chiropractor
  • Park Rapids, MN
  • NPI 1417358490
  Medicare reassignment NPD Authorized official
• Pequot Lakes Chiropractic and Sports Injury Center P.a

  • Chiropractor
  • Pequot Lakes, MN
  • NPI 1376602656
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1013285626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 1ST ST E",
            "address_2": "SUITE 101",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701707",
            "telephone_number": "218-366-2174",
            "fax_number": "218-366-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PARK AVE N",
            "address_2": "SUITE 101",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701598",
            "telephone_number": "218-366-2174",
            "fax_number": "218-366-2175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JEREMY",
        "middle_name": "JOHN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-09",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Mjelde
• Moeller Murray PA (Northwoods Dental Clinic)
• Deborah Kay Montzka, D.C.
• Hyacinth Rose Mosse, LSW
• Gladys Marie Murphy
• Lora Lynne Nelson, D.D.S.
• Mary Jane Nelson, APRN-C
• Kathryn L Nevins, CNP
• Nisene Dialysis, LLC (Park Rapids Dialysis)
• Michelle Marie Noffze, LPCC

• Chiropractor in Park Rapids, MN
• Providers in Park Rapids, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.