Provider Demographics
NPI:1154345668
Name:GROSSMAN-OLSON, KATANAH ROSE (DC)
Entity type:Individual
Prefix:
First Name:KATANAH
Middle Name:ROSE
Last Name:GROSSMAN-OLSON
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 1:416 NW 13TH AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2934
Mailing Address - Country:US
Mailing Address - Phone:503-961-5618
Mailing Address - Fax:
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 220
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9739
Practice Address - Country:US
Practice Address - Phone:503-908-0881
Practice Address - Fax:503-908-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor