Provider Demographics
NPI:1710194980
Name:OLSON, DEBRA SUE (DC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:OLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44967 N 10TH ST WEST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2313
Mailing Address - Country:US
Mailing Address - Phone:661-942-8686
Mailing Address - Fax:661-723-3046
Practice Address - Street 1:44967 N 10TH ST WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2313
Practice Address - Country:US
Practice Address - Phone:661-942-8686
Practice Address - Fax:661-723-3046
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12075Medicare PIN
CAWDC21767AMedicare PIN
U40222Medicare UPIN