Provider Demographics
NPI:1548258320
Name:OLSON, SCOTT VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:VINCENT
Last Name:OLSON
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 1:1693 SW CHANDLER AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3236
Mailing Address - Country:US
Mailing Address - Phone:541-322-8885
Mailing Address - Fax:541-322-6800
Practice Address - Street 1:1693 SW CHANDLER AVE
Practice Address - Street 2:STE 130
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3236
Practice Address - Country:US
Practice Address - Phone:541-322-8885
Practice Address - Fax:541-322-6800
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3562111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU52153Medicare UPIN