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General NPI Number Information
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NPI Number | 1386786283
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Entity Type | Organization
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Legal Business Name | OLSEN CLINIC OF CHIROPRACTIC PLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 4233 COLONIAL AVE
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City | ROANOKE
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State | VA
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Zip | 24018-4002
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Country | US
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Telephone | 540-772-8000
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Fax | 540-989-0831
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Provider Business Mailing Address
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Address Line | 4233 COLONIAL AVE
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City | ROANOKE
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State | VA
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Zip | 24018-4002
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Country | US
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Telephone | 540-772-8000
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Fax | 540-989-0831
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN CHRISTIAN OLSEN
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Credential | D.C.
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Telephone | 540-772-8000
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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 | 0104001740
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License Number State | VA
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