Provider Demographics
NPI:1235493388
Name:OLSON, RICHARD LEE (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
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 1:805 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1307
Mailing Address - Country:US
Mailing Address - Phone:715-748-2334
Mailing Address - Fax:715-748-1124
Practice Address - Street 1:805 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1307
Practice Address - Country:US
Practice Address - Phone:715-748-2334
Practice Address - Fax:715-748-1124
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2562-012111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition