Provider Demographics
NPI:1285628685
Name:OLSHANSKY, MARINA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:OLSHANSKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22358 CYPRESS PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4089
Mailing Address - Country:US
Mailing Address - Phone:415-577-8460
Mailing Address - Fax:
Practice Address - Street 1:9700 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4409
Practice Address - Country:US
Practice Address - Phone:415-577-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0293180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99751Medicare UPIN
CADC0293180Medicare ID - Type Unspecified