Provider Demographics
NPI:1568763597
Name:OLAFSSON, JASON T (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:OLAFSSON
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 1:3631 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1506
Mailing Address - Country:US
Mailing Address - Phone:248-391-5400
Mailing Address - Fax:248-391-5404
Practice Address - Street 1:3631 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1506
Practice Address - Country:US
Practice Address - Phone:248-391-5400
Practice Address - Fax:248-391-5404
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor