Healthcare Provider Details

I. General information

NPI: 1023050184
Provider Name (Legal Business Name): DANIEL OLSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S MAIN ST
DELTA CO
81416-2407
US

IV. Provider business mailing address

PO BOX 1129
DELTA CO
81416-1129
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-9595
  • Fax:
Mailing address:
  • Phone: 970-874-7225
  • Fax: 970-874-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number30332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: