Provider Demographics
NPI:1417089442
Name:OLSEN, NATHAN ELDON (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ELDON
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 1:621 SE 168TH AVE APT 98
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9632
Mailing Address - Country:US
Mailing Address - Phone:360-260-1105
Mailing Address - Fax:
Practice Address - Street 1:2058 E FRANKLIN RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8001
Practice Address - Country:US
Practice Address - Phone:208-286-2124
Practice Address - Fax:208-855-5915
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor