Provider Demographics
NPI:1902887672
Name:OLESON, GREG E (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:E
Last Name:OLESON
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 1:514 1ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARMSTRONG
Mailing Address - State:IA
Mailing Address - Zip Code:50514
Mailing Address - Country:US
Mailing Address - Phone:712-868-3265
Mailing Address - Fax:712-868-3499
Practice Address - Street 1:514 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:ARMSTRONG
Practice Address - State:IA
Practice Address - Zip Code:50514
Practice Address - Country:US
Practice Address - Phone:712-868-3265
Practice Address - Fax:712-868-3499
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05772111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118646Medicaid
IA17380Medicare ID - Type Unspecified
IA0118646Medicaid