Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2899 | MN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2899 | MN |
NPI | 1659659159 |
---|---|
Provider Name | Dr. Bradley Owen Olson |
First Address | Hutchinson, MN 55350-3301 |
Second Address | Hutchinson, MN 55350-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 01/08/2011 |