Provider Demographics
NPI:1629281860
Name:OLSON, GREG TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:TODD
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 1:3107 PENN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1123
Mailing Address - Country:US
Mailing Address - Phone:612-522-0440
Mailing Address - Fax:612-522-1816
Practice Address - Street 1:3107 PENN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1123
Practice Address - Country:US
Practice Address - Phone:612-522-0440
Practice Address - Fax:612-522-1816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39524Medicare UPIN
MN350000357Medicare ID - Type Unspecified