Provider Demographics
NPI:1255474144
Name:OLSEN, JOHN CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:OLSEN
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 1:4034 W. VAN GIESEN STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353
Mailing Address - Country:US
Mailing Address - Phone:509-967-5500
Mailing Address - Fax:509-967-5501
Practice Address - Street 1:4034 W. VAN GIESEN STREET
Practice Address - Street 2:SUITE E
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353
Practice Address - Country:US
Practice Address - Phone:509-967-5500
Practice Address - Fax:509-967-5501
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60147006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65258Medicare UPIN
VAU65258Medicare UPIN
VA350000743Medicare PIN