Provider Demographics
NPI:1033321724
Name:HEIDI E OLSON PROFESSIONAL CHIRO CORP
Entity Type:Organization
Organization Name:HEIDI E OLSON PROFESSIONAL CHIRO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ELLE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-602-5000
Mailing Address - Street 1:1290 MONUMENT BLVD. #B
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4480
Mailing Address - Country:US
Mailing Address - Phone:925-602-5000
Mailing Address - Fax:925-602-5003
Practice Address - Street 1:1290 MONUMENT BLVD. #B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4480
Practice Address - Country:US
Practice Address - Phone:925-602-5000
Practice Address - Fax:925-602-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65399Medicare UPIN