Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2540 | WA |
NPI | 1003981028 |
---|---|
Provider Name | Dr. Todd Allen Olson |
First Address | Lynden, WA 98264-0570 |
Second Address | Lynden, WA 98264-9151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U21650 | (02) | WA |