Provider Demographics
NPI:1023058856
Name:OLSEN, SHAUNA LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:LEE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 S VIRGINIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2834
Mailing Address - Country:US
Mailing Address - Phone:775-826-5575
Mailing Address - Fax:775-826-4494
Practice Address - Street 1:1699 S VIRGINIA ST
Practice Address - Street 2:STE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2834
Practice Address - Country:US
Practice Address - Phone:775-826-5575
Practice Address - Fax:775-826-4494
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21766111N00000X
NVB502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
31133Medicare ID - Type Unspecified