Healthcare Provider Details

I. General information

NPI: 1679926604
Provider Name (Legal Business Name): ROBERT D. OLSON INTEGRATIVE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 BOARDWALK STE 305
SAN MARCOS CA
92078-2659
US

IV. Provider business mailing address

PO BOX 546
CARDIFF CA
92007-0546
US

V. Phone/Fax

Practice location:
  • Phone: 858-436-7600
  • Fax: 760-797-1845
Mailing address:
  • Phone: 858-436-7600
  • Fax: 760-797-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: ROBERT D OLSON
Title or Position: OFFICER
Credential: DC
Phone: 858-436-7600