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General NPI Number Information
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NPI Number | 1316075799
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Entity Type | Organization
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Legal Business Name | OLSON CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 130 LAKE BOULEVARD SOUTH
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City | BUFFALO
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State | MN
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Zip | 55313-1448
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Country | US
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Telephone | 763-682-1849
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Fax | 763-684-1864
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Provider Business Mailing Address
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Address Line | 130 LAKE BLVD S
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City | BUFFALO
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State | MN
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Zip | 55313-1448
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Country | US
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Telephone | 763-682-1849
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Fax | 763-684-1864
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DALE OLSON
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Credential | DC
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Telephone | 763-682-1849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2573
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License Number State | MN
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