Provider Demographics
NPI:1659659159
Name:OLSON, BRADLEY OWEN (DC AC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:OWEN
Last Name:OLSON
Suffix:
Gender:M
Credentials:DC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DELAWARE ST NW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3301
Mailing Address - Country:US
Mailing Address - Phone:320-587-3844
Mailing Address - Fax:
Practice Address - Street 1:1312 DELAWARE ST NW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3301
Practice Address - Country:US
Practice Address - Phone:320-587-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2899111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic