| |
301 Superior Ave, Tomah, WI 54660 | |
(608) 372-5922 | |
(608) 372-5950 |
Full Name | |
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Type | Facility |
Speciality | Preferred Provider Organization |
Location | 301 Superior Ave, Tomah, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316089741 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 3311-012 (Wisconsin) | Secondary |
305R00000X | Preferred Provider Organization | 3311-012 (Wisconsin) | Primary |
Provider Name | Brian W Olson |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1548297963 PECOS PAC ID: 7618143835 Enrollment ID: I20120110000109 |
Mailing Address | Practice Location Address |
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301 Superior Ave, Tomah, WI 54660 Ph: (608) 372-5922 | 301 Superior Ave, Tomah, WI 54660 Ph: (608) 372-5922 |