Provider Demographics
NPI:1790800878
Name:OLSON, A RAND (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:RAND
Last Name:OLSON
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BIG BEND SQUARE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:636-225-2121
Mailing Address - Fax:636-225-8122
Practice Address - Street 1:1360 BIG BEND SQ
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021
Practice Address - Country:US
Practice Address - Phone:636-225-2121
Practice Address - Fax:636-225-8122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor