Provider Demographics
NPI:1629659677
Name:OLSEN, JOHN THOMAS BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS BRADLEY
Last Name:OLSEN
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 1:520 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1141
Mailing Address - Country:US
Mailing Address - Phone:608-370-6408
Mailing Address - Fax:
Practice Address - Street 1:520 WATER ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1141
Practice Address - Country:US
Practice Address - Phone:608-370-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI565112111N00000X
WI5651-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty