Provider Demographics
NPI:1437694718
Name:OLSON, LANDON EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:EDWARD
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 1:1207 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2563
Mailing Address - Country:US
Mailing Address - Phone:320-491-4165
Mailing Address - Fax:
Practice Address - Street 1:507 N NOKOMIS ST STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2353
Practice Address - Country:US
Practice Address - Phone:320-762-2639
Practice Address - Fax:320-762-2650
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor