Provider Demographics
NPI:1114060936
Name:OLSEN, JAMES BRYANT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYANT
Last Name:OLSEN
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 1:4233 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4002
Mailing Address - Country:US
Mailing Address - Phone:540-772-8000
Mailing Address - Fax:540-989-0831
Practice Address - Street 1:4233 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4002
Practice Address - Country:US
Practice Address - Phone:540-772-8000
Practice Address - Fax:540-989-0831
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU75012Medicare UPIN
VA350000981Medicare PIN