Provider Demographics
NPI:1912221938
Name:OLSEN CHIROPRACTIC AND PERFORMANCE ENHANCEMENT
Entity Type:Organization
Organization Name:OLSEN CHIROPRACTIC AND PERFORMANCE ENHANCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-939-2450
Mailing Address - Street 1:5340 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6414
Mailing Address - Country:US
Mailing Address - Phone:208-461-6523
Mailing Address - Fax:802-461-9130
Practice Address - Street 1:232 2ND ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3709
Practice Address - Country:US
Practice Address - Phone:208-939-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty