Provider Demographics
NPI:1376553479
Name:OLSEN, CARA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:ROSE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:CARA
Other - Middle Name:ROSE
Other - Last Name:WALLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor