Provider Demographics
NPI:1598829483
Name:OLSON, KRISTINA LC215534 (LAC, DIPOM)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LC215534
Last Name:OLSON
Suffix:
Gender:F
Credentials:LAC, DIPOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W HARVARD ST
Mailing Address - Street 2:#2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2185
Mailing Address - Country:US
Mailing Address - Phone:970-204-1728
Mailing Address - Fax:970-204-1728
Practice Address - Street 1:116 W HARVARD ST
Practice Address - Street 2:#2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2185
Practice Address - Country:US
Practice Address - Phone:970-204-1728
Practice Address - Fax:970-204-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist