Provider Demographics
NPI:1154479707
Name:OLSON, SPENCER HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:HOWARD
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 1:3180 SOLOMONS ISLAND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1700
Mailing Address - Country:US
Mailing Address - Phone:410-956-2955
Mailing Address - Fax:410-956-6255
Practice Address - Street 1:3180 SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1700
Practice Address - Country:US
Practice Address - Phone:410-956-2955
Practice Address - Fax:410-956-6255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1256PT111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM607Medicare ID - Type Unspecified
MDT59593Medicare UPIN