Provider Demographics
NPI:1417495086
Name:ROBERT D. OLSON INTEGRATIVE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ROBERT D. OLSON INTEGRATIVE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-436-7600
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0546
Mailing Address - Country:US
Mailing Address - Phone:858-436-7600
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:906 SYCAMORE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7828
Practice Address - Country:US
Practice Address - Phone:760-940-0500
Practice Address - Fax:760-842-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB258976Medicare PIN