Provider Demographics
NPI:1144581828
Name:OLSON, TRACY L (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18174 ADAMS CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3062
Mailing Address - Country:US
Mailing Address - Phone:678-836-5672
Mailing Address - Fax:
Practice Address - Street 1:18174 ADAMS CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-3062
Practice Address - Country:US
Practice Address - Phone:678-836-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13310111NS0005X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician