Provider Demographics
NPI:1679097711
Name:NELSON, RYAN AUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:AUSTIN
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 1:869 LOGGERS CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1892
Mailing Address - Country:US
Mailing Address - Phone:248-930-2775
Mailing Address - Fax:
Practice Address - Street 1:30900 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1892
Practice Address - Country:US
Practice Address - Phone:734-838-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor