Provider Demographics
NPI:1659353399
Name:OLSEN, ROBERT V (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
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 1:7107 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4688
Mailing Address - Country:US
Mailing Address - Phone:773-237-4545
Mailing Address - Fax:773-237-9720
Practice Address - Street 1:7107 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4688
Practice Address - Country:US
Practice Address - Phone:773-237-4545
Practice Address - Fax:773-237-9720
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL574100Medicare ID - Type Unspecified