| Organization Name: | JESSE D. OLSON |
| NPI Number: | 1124286760 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESSE D OLSON (OWNER) |
| Mailing Address: | 202 Island Dr Suite 1 Fort Pierre |
| State: | SD US |
| Postal Code: | 575327302 |
| Phone Number: | 6052220661 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2008 |
| NPI Last Update Date: | 06/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |