MEDICARE: KIERSTIN LEIGH OLSON L.AC, MSOM, BS

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
1	171100000X	Acupuncturist	1853	MN

General Provider Information

NPI Number	:	1265916811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERSTIN LEIGH OLSON L.AC, MSOM, BS

Provider Business Mailing Address
First Line	:	1270 TIMBERSHORE LN
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1019
Country	:	US
Telephone Number	:	651-329-6815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3546 DAKOTA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2313
Country	:	US
Telephone Number	:	952-417-6433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/19/2018

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