MEDICARE: DR. DANIEL RAY OLSON D.C.

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	111N00000X	Chiropractor	4556	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	307P4OL	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396765285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RAY OLSON D.C.

Provider Business Mailing Address
First Line	:	2400 COUNTY ROAD D W
Second Line	:	#101
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-7564
Country	:	US
Telephone Number	:	651-633-0155
Fax Number	:	651-604-2935

Provider Business Practice Location Address
First Line	:	2400 COUNTY ROAD D W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-7564
Country	:	US
Telephone Number	:	651-633-0155
Fax Number	:	651-604-2935

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/28/2012

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