Provider Demographics
NPI:1457485575
Name:OLSON, LORI (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1173
Mailing Address - Country:US
Mailing Address - Phone:612-741-2736
Mailing Address - Fax:612-252-0379
Practice Address - Street 1:208 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1173
Practice Address - Country:US
Practice Address - Phone:612-741-2736
Practice Address - Fax:612-252-0379
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4083111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111T5POOtherBCBS PROVIDER NUMBER
MN451804700Medicaid
MN111T5POOtherBCBS PROVIDER NUMBER
MNU87856Medicare UPIN