Provider Demographics
NPI:1992397111
Name:OLSON, MITCHELL C (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
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 1:3145 FLORIDA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3025
Mailing Address - Country:US
Mailing Address - Phone:763-291-8830
Mailing Address - Fax:
Practice Address - Street 1:4900 HIGHWAY 169 N STE 250
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4019
Practice Address - Country:US
Practice Address - Phone:763-432-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor