Provider Demographics
NPI:1184034670
Name:OLSON, KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
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 1:811 S PERRYVILLE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-4323
Mailing Address - Country:US
Mailing Address - Phone:779-423-2044
Mailing Address - Fax:779-423-2045
Practice Address - Street 1:811 S PERRYVILLE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4323
Practice Address - Country:US
Practice Address - Phone:779-423-2044
Practice Address - Fax:779-423-2045
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor