Provider Demographics
NPI:1982836631
Name:OLSEN, JOHN KURT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KURT
Last Name:OLSEN
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 1:392 E 12300 S STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8043
Mailing Address - Country:US
Mailing Address - Phone:801-849-1029
Mailing Address - Fax:
Practice Address - Street 1:392 E 12300 S STE C
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8043
Practice Address - Country:US
Practice Address - Phone:801-849-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7413155-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477785889OtherBUSINESS NPI