Provider Demographics
NPI:1235220997
Name:OLSON, ANDREW R
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-4409
Mailing Address - Country:US
Mailing Address - Phone:601-735-9373
Mailing Address - Fax:601-735-5897
Practice Address - Street 1:134 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-4409
Practice Address - Country:US
Practice Address - Phone:601-735-9373
Practice Address - Fax:601-735-5897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115018Medicaid
MS00115018Medicaid