Provider Demographics
NPI:1679695712
Name:NELSON, CALVIN LEE JR (DC)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:LEE
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:902 ARLINGTON CTR PMB 333
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-447-1873
Mailing Address - Fax:580-559-2348
Practice Address - Street 1:927 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4034
Practice Address - Country:US
Practice Address - Phone:580-447-1873
Practice Address - Fax:580-559-2348
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2024-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK3428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731539588001OtherBLUE CROSS BLUE SHIELD
U69796Medicare UPIN