Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301009914 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 038011079 | IL |
NPI | 1265600993 |
---|---|
Provider Name | Dr. Amy B. Olson |
First Address | Novi, MI 48375-1219 |
Second Address | Novi, MI 48375-1219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 04/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212347 | (02) | IL |