Healthcare Provider Details

I. General information

NPI: 1992397111
Provider Name (Legal Business Name): MITCHELL C OLSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HIGHWAY 169 N STE 250
NEW HOPE MN
55428-4019
US

IV. Provider business mailing address

3145 FLORIDA AVE N
CRYSTAL MN
55427-3025
US

V. Phone/Fax

Practice location:
  • Phone: 763-432-0116
  • Fax:
Mailing address:
  • Phone: 763-291-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6815
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: