Healthcare Provider Details

I. General information

NPI: 1316147077
Provider Name (Legal Business Name): MICHAEL J. OLSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CASCADE ST. N.
OSCEOLA WI
54020-0068
US

IV. Provider business mailing address

307 CASCADE ST. N. P.O. BOX 68
OSCEOLA WI
54020-0068
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-3211
  • Fax: 715-417-3103
Mailing address:
  • Phone: 715-294-3211
  • Fax: 715-417-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J. OLSON
Title or Position: OWNER
Credential: D.C.
Phone: 715-294-3211