Provider Demographics
NPI:1053301481
Name:NELSON, CRAIG (DC)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7701
Mailing Address - Country:US
Mailing Address - Phone:518-373-9999
Mailing Address - Fax:518-373-8887
Practice Address - Street 1:1539 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-7701
Practice Address - Country:US
Practice Address - Phone:518-373-9999
Practice Address - Fax:518-373-8887
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3127Medicare PIN
NYU92621Medicare UPIN