Provider Demographics
NPI:1942621453
Name:OLESON CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:OLESON CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:OLESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-868-3265
Mailing Address - Street 1:514 1ST AVE
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:ARMSTRONG
Mailing Address - State:IA
Mailing Address - Zip Code:50514-7700
Mailing Address - Country:US
Mailing Address - Phone:712-868-3265
Mailing Address - Fax:712-868-3499
Practice Address - Street 1:514 1ST AVE
Practice Address - Street 2:
Practice Address - City:ARMSTRONG
Practice Address - State:IA
Practice Address - Zip Code:50514-7700
Practice Address - Country:US
Practice Address - Phone:712-868-3265
Practice Address - Fax:712-868-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05772111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118646Medicaid
IA0118646Medicaid
IA17380Medicare PIN