Provider Demographics
NPI:1033274154
Name:OLSON, DONALD WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:OLSON
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 1:1020 A ST SE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6063
Mailing Address - Country:US
Mailing Address - Phone:253-939-0909
Mailing Address - Fax:253-939-1813
Practice Address - Street 1:1020 A ST SE
Practice Address - Street 2:SUITE 4
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6063
Practice Address - Country:US
Practice Address - Phone:253-939-0909
Practice Address - Fax:253-939-1813
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032779Medicaid
WA8868653OtherMEDICARE PTAN
WA2032779Medicaid