Fred C. Nelson, D.C., C.C.S.P.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

1075 Issued in NC

Practice address

10405 Ligon Mill Rd Ste F
Wake Forest, NC 27587-5013

Phone

(919) 556-2014

Fax

(919) 556-0996

NPI assigned

Jul 7, 2006

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

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Russ C Redd DC PLLC

  • Chiropractor
  • Wake Forest, NC
  • NPI 1316332307
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316979495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10405 LIGON MILL RD STE F",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875013",
            "telephone_number": "919-556-2014",
            "fax_number": "919-556-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10405 LIGON MILL RD STE F",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875013",
            "telephone_number": "919-556-2014",
            "fax_number": "919-556-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "FRED",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.C., C.C.S.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NC",
            "license": "1075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "666372",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NC",
            "identifier": "08664",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8908664",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/HMO",
            "identifier": "2343112",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/NON-HMO",
            "identifier": "4455933",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NC Family Wellness and Recovery, LLC
• Nancy M Nealious, PSYD
• Christian Nechyba, M.D.
• Caroline Neideffer
• Neighborhood Medical Centers, Inc
• Grant H Nelson, DPT
• Sara Nepal
• Neuro Community Care
• New Path Consultations, LLC
• Christina Theresa Newman, AGPCNP - BC

• All providers in Wake Forest, NC
• Sports Physician Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.