Healthcare Provider Details

I. General information

NPI: 1316089741
Provider Name (Legal Business Name): BRIAN W OLSON & ASSOCIATES S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SUPERIOR AVE
TOMAH WI
54660
US

IV. Provider business mailing address

301 SUPERIOR AVE
TOMAH WI
54660
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-5922
  • Fax: 608-372-5950
Mailing address:
  • Phone: 608-372-5922
  • Fax: 608-372-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number3311-012
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3311-012
License Number StateWI

VIII. Authorized Official

Name: BRIAN WILLIAM OLSON
Title or Position: OWNER
Credential:
Phone: 608-372-5922