Active NPI
Grant E Nelson, DC
- Chiropractor
- Wildwood, MO
National Provider Identifier
1508438334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2021022187
- Practice address
- 16921 Manchester Rd Suite B
Wildwood, MO 63040-3623 - Phone
- (314) 377-7050
- NPI assigned
- Jul 12, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHR.0008397 | CO | |
| Chiropractor | 111N00000X | 2021022187 | MO | Primary |
Addresses
Primary practice location
16921 Manchester Rd Suite B
Wildwood, MO 63040-3623
Mailing address
16921 Manchester Rd Suite B
Wildwood, MO 63040-3623
Phone (314) 377-7050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHR.0008397 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1508438334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16921 MANCHESTER RD SUITE B",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630403623",
"telephone_number": "314-377-7050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16921 MANCHESTER RD SUITE B",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630403623",
"telephone_number": "314-377-7050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "GRANT",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-12",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CO",
"license": "CHR.0008397",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2021022187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wildwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.