Provider Demographics
NPI:1063402626
Name:OLSEN, ERIC NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NEIL
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6561
Mailing Address - Country:US
Mailing Address - Phone:423-238-5056
Mailing Address - Fax:423-238-5057
Practice Address - Street 1:6857 MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 105
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6561
Practice Address - Country:US
Practice Address - Phone:423-238-5056
Practice Address - Fax:423-238-5057
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN001099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4102564OtherBCBS
TN4102564OtherBCBS
U46923Medicare UPIN
3677062Medicare PIN