Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR008992 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | CH13310 | FL |
NPI | 1144581828 |
---|---|
Provider Name | Ms. Tracy L. Olson |
First Address | Estero, FL 33928 |
Second Address | Estero, FL 33928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 10/11/2021 |