Individual provider Active NPI

Dusty L Nielsen, D.C.

  • Chiropractor
  • Woodward, OK
National Provider Identifier
1184801623
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3860 Issued in OK
Practice address
1502 Oklahoma Ave
Woodward, OK 73801-4357
Phone
(580) 256-3122
Fax
(580) 254-3839
NPI assigned
Jan 28, 2008
Last updated
Jun 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3860 OK Primary

Addresses

Primary practice location

1502 Oklahoma Ave
Woodward, OK 73801-4357

Mailing address

1502 Oklahoma Ave
Woodward, OK 73801-4357
Phone (580) 256-3122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080513000378 OK Practitioner - Chiropractic 2163591496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1502 Oklahoma Ave
Woodward, OK 73801-4357
Phone (580) 256-3122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3860OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dusty Nielsen, D.C. P.L.L.C. CurrentSince Feb 1, 2008 Accepting new patients
Richard D. Brown MD, Inc. PastSince Feb 1, 2008 Accepting new patients

Locations

1502 Oklahoma Ave
Woodward, OK 73801
Phone (580) 256-3122

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370217600000",
    "number": "1184801623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 OKLAHOMA AVE",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738014357",
            "telephone_number": "580-256-3122",
            "fax_number": "580-254-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 OKLAHOMA AVE",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738014357",
            "telephone_number": "580-256-3122",
            "fax_number": "580-254-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "DUSTY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-28",
        "last_updated": "2013-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodward, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; 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.