Provider Demographics
NPI:1841370053
Name:ASPEN MANAGMENT SERVICES INC
Entity type:Organization
Organization Name:ASPEN MANAGMENT SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAVESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-552-9886
Mailing Address - Street 1:645 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5596
Mailing Address - Country:US
Mailing Address - Phone:208-552-9886
Mailing Address - Fax:208-552-9843
Practice Address - Street 1:657 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5596
Practice Address - Country:US
Practice Address - Phone:208-552-9886
Practice Address - Fax:208-552-9843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN MANAGEMENT SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTC126OtherBLUE CROSS PROVIDER NO
ID000010149844OtherBLUE SHIELD PROVIDER NO
IDTC126OtherBLUE CROSS PROVIDER NO