Healthcare Provider Details

I. General information

NPI: 1144581828
Provider Name (Legal Business Name): TRACY L. OLSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18174 ADAMS CIR
FORT MYERS FL
33967-3062
US

IV. Provider business mailing address

18174 ADAMS CIR
FORT MYERS FL
33967-3062
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-5672
  • Fax:
Mailing address:
  • Phone: 678-836-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH13310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: