Provider Demographics
NPI:1245710623
Name:OLSON, BRIAN ALDEN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALDEN
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E4936 COUNTY ROAD KK
Mailing Address - Street 2:
Mailing Address - City:CHASEBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54621-8053
Mailing Address - Country:US
Mailing Address - Phone:608-790-6488
Mailing Address - Fax:
Practice Address - Street 1:E4936 COUNTY ROAD KK
Practice Address - Street 2:
Practice Address - City:CHASEBURG
Practice Address - State:WI
Practice Address - Zip Code:54621-8053
Practice Address - Country:US
Practice Address - Phone:608-790-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty