Provider Demographics
NPI:1003981028
Name:OLSON, TODD ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALLEN
Last Name:OLSON
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:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-0570
Mailing Address - Country:US
Mailing Address - Phone:360-318-1240
Mailing Address - Fax:360-318-8918
Practice Address - Street 1:8304 GUIDE MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9151
Practice Address - Country:US
Practice Address - Phone:360-318-1240
Practice Address - Fax:360-318-8918
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB08412Medicare ID - Type Unspecified
WAU21650Medicare UPIN