Provider Demographics
NPI:1295881464
Name:OLSON, OLE J (DC)
Entity type:Individual
Prefix:DR
First Name:OLE
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1065 WESTMORE MEYERS RD
Mailing Address - Street 2:APT 206
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3293
Mailing Address - Country:US
Mailing Address - Phone:319-290-3136
Mailing Address - Fax:708-354-9799
Practice Address - Street 1:507 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6740
Practice Address - Country:US
Practice Address - Phone:708-354-9599
Practice Address - Fax:708-354-9799
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor