Provider Demographics
NPI:1033134440
Name:OLSON, THOMAS M (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
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 1:4362 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4107
Mailing Address - Country:US
Mailing Address - Phone:916-481-6829
Mailing Address - Fax:916-481-6830
Practice Address - Street 1:4362 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4107
Practice Address - Country:US
Practice Address - Phone:916-481-6829
Practice Address - Fax:916-481-6830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
91-1765493OtherIRS TAXPAYER ID
CADC0166611Medicare PIN
91-1765493OtherIRS TAXPAYER ID