Healthcare Provider Details

I. General information

NPI: 1255485991
Provider Name (Legal Business Name): ROBERT W OHLSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W 1ST ST
GENESEO IL
61254-1343
US

IV. Provider business mailing address

442 RIDGE DR
GENESEO IL
61254-9130
US

V. Phone/Fax

Practice location:
  • Phone: 309-944-5128
  • Fax:
Mailing address:
  • Phone: 309-441-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: