Provider Demographics
NPI:1497764914
Name:OLSEN, WAYNE MERLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MERLIN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1355 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5981
Mailing Address - Country:US
Mailing Address - Phone:801-298-9190
Mailing Address - Fax:801-298-2451
Practice Address - Street 1:1355 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5981
Practice Address - Country:US
Practice Address - Phone:801-298-9190
Practice Address - Fax:801-298-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4821942-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT62884OtherPUBLIC EMPLOYEES HEALTH P
UTZZZZZZZOtherUNITED HEALTH CARE
UT691629OtherDESERET MUTUAL BENEFITS
UT48219421200001OtherFEDERAL BLUE CROSS
UT107003489101OtherSELECT HEALTH
UT48219421200001OtherREGENCE BLUE CROSS
UTP00063641OtherPALMETTO