Provider Demographics
NPI:1568680221
Name:OLSON, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
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 1:909 BROADWAY AVE
Mailing Address - Street 2:10
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3547
Mailing Address - Country:US
Mailing Address - Phone:605-665-2434
Mailing Address - Fax:605-665-2434
Practice Address - Street 1:909 BROADWAY AVE
Practice Address - Street 2:10
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3547
Practice Address - Country:US
Practice Address - Phone:605-665-2434
Practice Address - Fax:605-665-2434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD721111N00000X
NE928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS86573Medicare ID - Type Unspecified
NE091584Medicare ID - Type Unspecified