Provider Demographics
NPI:1093989188
Name:DR. GARY OLSON DC PC
Entity Type:Organization
Organization Name:DR. GARY OLSON DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-462-0917
Mailing Address - Street 1:285 COMMACK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3403
Mailing Address - Country:US
Mailing Address - Phone:631-462-0917
Mailing Address - Fax:631-462-1038
Practice Address - Street 1:285 COMMACK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3403
Practice Address - Country:US
Practice Address - Phone:631-462-0917
Practice Address - Fax:631-462-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX9B411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7S551OtherBLUE CROSS BLUE SHIELD
NY5897489OtherGHI
NYX7S551OtherBLUE CROSS BLUE SHIELD