Provider Demographics
NPI:1629218508
Name:OLSEN, WALTER CLARK (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CLARK
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7900 BAILEY COVE RD SE
Mailing Address - Street 2:SUITE 7-A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3324
Mailing Address - Country:US
Mailing Address - Phone:256-270-8700
Mailing Address - Fax:256-270-8702
Practice Address - Street 1:7900 BAILEY COVE RD SE
Practice Address - Street 2:SUITE 7-A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3324
Practice Address - Country:US
Practice Address - Phone:256-270-8700
Practice Address - Fax:256-270-8702
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor