Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3562 | OR |
NPI | 1548258320 |
---|---|
Provider Name | Dr. Scott Vincent Olson |
First Address | Bend, OR 97702-3236 |
Second Address | Bend, OR 97702-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U52153 | (02) | UT |