MEDICARE: ROBERT D. OLSON INTEGRATIVE CHIROPRACTIC INC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1740471234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D. OLSON INTEGRATIVE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 546
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-0546
Country	:	US
Telephone Number	:	858-436-7600
Fax Number	:	760-797-1845

Provider Business Practice Location Address
First Line	:	902 SYCAMORE AVE
Second Line	:	SUITE 201
City	:	VISTA
State	:	CA
Zip	:	92081-7815
Country	:	US
Telephone Number	:	760-940-0500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ROBERT D. OLSON
Credential	:	DC
Telephone Number	:	858-436-7600

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	07/26/2017

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