Provider Demographics
NPI:1265460778
Name:OLSON, RICHARD PAUL (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
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 1:485 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:485 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2279
Practice Address - Country:US
Practice Address - Phone:801-489-4990
Practice Address - Fax:801-489-4990
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5409134-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT821037OtherDMBA
UT74999OtherPEHP
UT74143OtherALTIUS
UT54091341277001OtherBLUE CROSS BLUE SHIELD
UT870395551OR2OtherEDUCATORS MUTUAL
UT54091341277001OtherBLUE CROSS BLUE SHIELD
UT870395551OR2OtherEDUCATORS MUTUAL