Provider Demographics
NPI:1215219068
Name:OLSEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:OLSEN CHIROPRACTIC, LLC
Other - Org Name:JUST FOR THE HEALTH OF IT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-241-6630
Mailing Address - Street 1:2402 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-241-6630
Mailing Address - Fax:360-567-0620
Practice Address - Street 1:2402 BROADWAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-241-6630
Practice Address - Fax:360-567-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60320567111N00000X
WACH00034644111N00000X
WAMA60190315225700000X
WAMA60236454225700000X
WAMA60239117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty