Healthcare Provider Details

I. General information

NPI: 1760104202
Provider Name (Legal Business Name): ALEXANDRA OLSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E 106TH ST
CARMEL IN
46280-1423
US

IV. Provider business mailing address

1003 E 106TH ST
CARMEL IN
46280-1423
US

V. Phone/Fax

Practice location:
  • Phone: 630-301-4949
  • Fax:
Mailing address:
  • Phone: 630-301-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number08003330A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: