Provider Demographics
NPI:1629123575
Name:OLSON, RUSSELL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JAMES
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 1:4010 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3071
Mailing Address - Country:US
Mailing Address - Phone:713-920-2255
Mailing Address - Fax:713-920-2255
Practice Address - Street 1:4010 FAIRMONT PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3071
Practice Address - Country:US
Practice Address - Phone:713-920-2255
Practice Address - Fax:713-920-2255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor