Individual
GARY L OLAVESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
657 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5596
(208) 552-9886
(208) 552-9843
Mailing address
645 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5596
(208) 552-9886
(208) 552-9843
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA871
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025345
BLUE SHIELD
ID
01
—
C4546
BLUE CROSS
ID
Enumeration date
07/26/2006
Last updated
09/14/2017
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