Provider Demographics
NPI:1336624840
Name:OLSON, BERNARD IV (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:OLSON
Suffix:IV
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 1:1290 S 3RD ST W STE A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2397
Mailing Address - Country:US
Mailing Address - Phone:406-926-1441
Mailing Address - Fax:
Practice Address - Street 1:1290 S 3RD ST W STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2397
Practice Address - Country:US
Practice Address - Phone:406-926-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-5544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor