Provider Demographics
NPI:1174794457
Name:OLAVESON, JEFF C (DC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:C
Last Name:OLAVESON
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 1:135 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1449
Mailing Address - Country:US
Mailing Address - Phone:208-745-1109
Mailing Address - Fax:208-745-1811
Practice Address - Street 1:135 S STATE ST
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1449
Practice Address - Country:US
Practice Address - Phone:208-745-1109
Practice Address - Fax:208-745-1811
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor