Provider Demographics
NPI:1366052334
Name:OLSON, BRADLEY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
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 1:5205 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-2006
Mailing Address - Country:US
Mailing Address - Phone:612-205-4582
Mailing Address - Fax:
Practice Address - Street 1:2424 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1269
Practice Address - Country:US
Practice Address - Phone:952-894-5108
Practice Address - Fax:952-890-5950
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor