MEDICARE: OLSON BROS. CHIROPRACTIC PA

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	427	MN

General Provider Information

NPI Number	:	1467642728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLSON BROS. CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	2400 COUNTY ROAD D W
Second Line	:	SUITE 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	:	SUITE 101
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	:	OFFICE MANAGER
Name	:	MRS. TERESA ANN NELSON
Credential	:
Telephone Number	:	651-633-0155

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	07/22/2013

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