Individual provider Active NPI

Richard Curtis Nelson, D.C.

  • Chiropractor
  • Moline, IL
National Provider Identifier
1992788517
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-008754 Issued in IL
Practice address
4509 Avenue of the Cities
Moline, IL 61265-4551
Phone
(309) 797-3182
Fax
(309) 757-8799
NPI assigned
Nov 29, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-008754 IL Primary

Addresses

Primary practice location

4509 Avenue of the Cities
Moline, IL 61265-4551

Mailing address

4509 Avenue of the Cities
Moline, IL 61265-4551
Phone (309) 797-3182

Other identifiers 2

IdentifierTypeStateIssuer
36-4284103OtherILTAX ID #
038-008754OtherILLICENSE #

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

LicenseStateTypeSpecialty
038-008754ILMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992788517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4509 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654551",
            "telephone_number": "309-797-3182",
            "fax_number": "309-757-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654551",
            "telephone_number": "309-797-3182",
            "fax_number": "309-757-8799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "RICHARD",
        "middle_name": "CURTIS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-008754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "36-4284103",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "038-008754",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • 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.