Provider Demographics
NPI:1760668693
Name:OLSON, ELIZABETH AGNES (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:AGNES
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 1:106 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1034
Mailing Address - Country:US
Mailing Address - Phone:651-345-2785
Mailing Address - Fax:651-345-5321
Practice Address - Street 1:106 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1034
Practice Address - Country:US
Practice Address - Phone:651-345-2785
Practice Address - Fax:651-345-5321
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor