MEDICARE: DR. PAMELA A 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	038.005679	IL

General Provider Information

NPI Number	:	1770719759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA A OLSON D.C.

Provider Business Mailing Address
First Line	:	1140 N MCLEAN BLVD
Second Line	:	SUITE C
City	:	ELGIN
State	:	IL
Zip	:	60123-1782
Country	:	US
Telephone Number	:	847-888-0411
Fax Number	:	847-741-6925

Provider Business Practice Location Address
First Line	:	1140 N MCLEAN BLVD
Second Line	:	SUITE C
City	:	ELGIN
State	:	IL
Zip	:	60123-1782
Country	:	US
Telephone Number	:	847-888-0411
Fax Number	:	847-741-6925

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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