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NPI Code Detail

MEDICARE: DR. ERIC NEIL OLSEN DC

MEDICARE: DR. ERIC NEIL OLSEN DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor001099TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14102564OTHERTNBCBS

General Provider Information

NPI Number : 1063402626
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC NEIL OLSEN DC
Provider Business Mailing Address
First Line : 6857 MOUNTAIN VIEW RD
Second Line : SUITE 105
City : OOLTEWAH
State : TN
Zip : 37363-6561
Country : US
Telephone Number : 423-238-5056
Fax Number : 423-238-5057
Provider Business Practice Location Address
First Line : 6857 MOUNTAIN VIEW RD
Second Line : SUITE 105
City : OOLTEWAH
State : TN
Zip : 37363-6561
Country : US
Telephone Number : 423-238-5056
Fax Number : 423-238-5057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 12/01/2008

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Directions to “ DR. ERIC NEIL OLSEN DC” Practice Location

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