=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629585567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. KADY OLSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2017
-----------------------------------------------------
Last Update Date | 12/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2625 HIGHWAY 14 W STE B
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-7597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-405-4257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 618 15TH ST NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-693-6349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6438
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------