Provider Demographics
NPI:1134292311
Name:OLSEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:OLSEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-859-5192
Mailing Address - Street 1:22672 LAMBERT ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1613
Mailing Address - Country:US
Mailing Address - Phone:949-859-5192
Mailing Address - Fax:949-583-2961
Practice Address - Street 1:22672 LAMBERT ST
Practice Address - Street 2:SUITE 620
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1613
Practice Address - Country:US
Practice Address - Phone:949-859-5192
Practice Address - Fax:949-583-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty