Provider Demographics
NPI:1063472785
Name:OLSEN, NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8515 PEARL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4810
Mailing Address - Country:US
Mailing Address - Phone:303-286-2888
Mailing Address - Fax:303-286-4036
Practice Address - Street 1:8515 PEARL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4810
Practice Address - Country:US
Practice Address - Phone:303-286-2888
Practice Address - Fax:303-286-4036
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33792208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90228359Medicaid
CO90228359Medicaid
COF88618Medicare UPIN