Provider Demographics
NPI:1780367417
Name:OLIN, MARK THOREAU (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOREAU
Last Name:OLIN
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 1:1250 5TH AVE N APT 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-6014
Mailing Address - Country:US
Mailing Address - Phone:510-904-7842
Mailing Address - Fax:
Practice Address - Street 1:1225 DEXTER AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3518
Practice Address - Country:US
Practice Address - Phone:206-497-4962
Practice Address - Fax:206-316-8655
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61462281111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation