Provider Demographics
NPI:1760143473
Name:OLSEN, PAIGE REBECCA (DC)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:REBECCA
Last Name:OLSEN
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 1:6815 CHIMNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7224
Mailing Address - Country:US
Mailing Address - Phone:248-894-5474
Mailing Address - Fax:
Practice Address - Street 1:13012 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1541
Practice Address - Country:US
Practice Address - Phone:502-253-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor