Provider Demographics
NPI:1194029173
Name:OLSON, RYAN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAY
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 1:130 LAKE BLVD S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1448
Mailing Address - Country:US
Mailing Address - Phone:763-682-1849
Mailing Address - Fax:763-684-1864
Practice Address - Street 1:130 LAKE BLVD S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1448
Practice Address - Country:US
Practice Address - Phone:763-682-1849
Practice Address - Fax:763-684-1864
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1194029173Medicaid
MN1194029173Medicaid
MNU06523Medicare UPIN