Provider Demographics
NPI:1851991491
Name:OLSON, KALEB (DC)
Entity Type:Individual
Prefix:DR
First Name:KALEB
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NE EWING ST
Mailing Address - Street 2:STE A
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2181
Mailing Address - Country:US
Mailing Address - Phone:515-259-0501
Mailing Address - Fax:319-359-4081
Practice Address - Street 1:112 NE EWING ST STE A
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2181
Practice Address - Country:US
Practice Address - Phone:515-320-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor