Provider Demographics
NPI:1881822047
Name:OLSEN, RYAN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WILLIAM
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 1:159 BUTLER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2328
Mailing Address - Country:US
Mailing Address - Phone:724-548-1040
Mailing Address - Fax:724-548-1044
Practice Address - Street 1:159 BUTLER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2328
Practice Address - Country:US
Practice Address - Phone:724-548-1040
Practice Address - Fax:724-548-1044
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor