Provider Demographics
NPI:1083779102
Name:'A' STREET CLINIC OF CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:'A' STREET CLINIC OF CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-939-0909
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty