Provider Demographics
NPI:1396765285
Name:OLSON, DANIEL RAY (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAY
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 1:2400 COUNTY ROAD D W
Mailing Address - Street 2:#101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7564
Mailing Address - Country:US
Mailing Address - Phone:651-633-0155
Mailing Address - Fax:651-604-2935
Practice Address - Street 1:2400 COUNTY ROAD D W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-7564
Practice Address - Country:US
Practice Address - Phone:651-633-0155
Practice Address - Fax:651-604-2935
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN307P4OLOtherBLUE CROSS BLUE SHIELD
MN307P4OLOtherBLUE CROSS BLUE SHIELD
MNV08017Medicare UPIN