Provider Demographics
NPI:1932220548
Name:OLSON, TERRY L (DC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
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:PO BOX 18
Mailing Address - Street 2:213 PARKWAY
Mailing Address - City:EAGLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56024-0018
Mailing Address - Country:US
Mailing Address - Phone:507-257-3726
Mailing Address - Fax:507-257-3726
Practice Address - Street 1:213 PARKWAY
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56024-0018
Practice Address - Country:US
Practice Address - Phone:507-257-3726
Practice Address - Fax:507-257-3726
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62653OLOtherBCBS
U02800Medicare UPIN