Provider Demographics
NPI:1811954399
Name:OLSON, STACEY (DC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 E SHEA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6662
Mailing Address - Country:US
Mailing Address - Phone:480-314-2262
Mailing Address - Fax:
Practice Address - Street 1:8424 E SHEA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6662
Practice Address - Country:US
Practice Address - Phone:480-314-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70998Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
AZU53284Medicare UPIN
AZ70997Medicare ID - Type UnspecifiedGROUP MEDICARE#