Provider Demographics
NPI:1508189507
Name:OLSEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:OLSEN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-548-1040
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty