Basic Information
| Provider Information | |||||||||
| NPI: | 1023050184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | DANIEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708747225 | ||||||||
| FaxNumber: | 9708747482 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708749595 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 30332 | CO | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | OL038533 | 01 | CO | BCBS IND PROV NUMBER | OTHER | 01303320 | 05 | CO | MEDICAID | 680565304001 | 01 | CO | RMHP PROVIDER NUMBER | OTHER |