Provider Demographics
NPI:1568497626
Name:OLSON, JULI LYNN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:JULI
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 30TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5753
Mailing Address - Country:US
Mailing Address - Phone:760-836-3644
Mailing Address - Fax:760-836-1914
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:760-836-3644
Practice Address - Fax:760-836-1914
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27562111N00000X
CAAC8287171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85676Medicare UPIN
CADC0275620Medicare ID - Type UnspecifiedCHIROPRACTIC MEDICARE