Provider Demographics
NPI:1598854655
Name:OLYNYK, LISA LINNEA (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LINNEA
Last Name:OLYNYK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:LINNEA
Other - Last Name:WITTROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1222 BRONSON WAY N
Mailing Address - Street 2:#100
Mailing Address - City:BENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-228-2824
Mailing Address - Fax:425-228-6956
Practice Address - Street 1:1222 BRONSON WAY N
Practice Address - Street 2:#100
Practice Address - City:BENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-228-2824
Practice Address - Fax:425-228-6956
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0211810OtherLABOR & INDUSTRIES
AB02601Medicare ID - Type Unspecified
U68674Medicare UPIN