Provider Demographics
NPI:1386664274
Name:OLSON, DENNIS LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
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 1:2400 COUNTY ROAD D W
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8503
Mailing Address - Country:US
Mailing Address - Phone:651-633-0155
Mailing Address - Fax:651-604-2935
Practice Address - Street 1:2400 COUNTY ROAD D W
Practice Address - Street 2:STE 101
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-8503
Practice Address - Country:US
Practice Address - Phone:651-633-0155
Practice Address - Fax:651-604-2935
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU99352Medicare UPIN
MN350003550Medicare ID - Type Unspecified