Active NPI
Kevin Richard Nelson, D.C.
- Chiropractor
- Thief River Falls, MN
National Provider Identifier
1356440283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3008
- Practice address
- 309 N Labree
Thief River Falls, MN 56701-1912 - Phone
- (218) 681-1565
- Fax
- (218) 681-1946
- NPI assigned
- Sep 21, 2006
- Last updated
- Jul 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3008 | MN | Primary |
Addresses
Primary practice location
309 N Labree
Thief River Falls, MN 56701-1912
Mailing address
309 Labree Ave N Ste 2
Thief River Falls, MN 56701-2020
Phone (218) 681-1565
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4K044TH | Other | MN | BLUE CROSS BLUE SHIELD |
| 822797011671 | Other | MN | PREFERRED ONE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 2, 2016 through Nov 2, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3008 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247011200000",
"number": "1356440283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 LABREE AVE N STE 2",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567012020",
"telephone_number": "218-681-1565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 N LABREE",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567011912",
"telephone_number": "218-681-1565",
"fax_number": "218-681-1946"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KEVIN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2009-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3008",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4K044TH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "822797011671",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thief River Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.