Healthcare Provider Details

I. General information

NPI: 1942621453
Provider Name (Legal Business Name): OLESON CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 1ST AVE
ARMSTRONG IA
50514-7700
US

IV. Provider business mailing address

514 1ST AVE PO BOX 246
ARMSTRONG IA
50514-7700
US

V. Phone/Fax

Practice location:
  • Phone: 712-868-3265
  • Fax: 712-868-3499
Mailing address:
  • Phone: 712-868-3265
  • Fax: 712-868-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberA05772
License Number StateIA

VIII. Authorized Official

Name: DR. GREG OLESON
Title or Position: DC/OWNER
Credential:
Phone: 712-868-3265