1497764914 NPI number — DR. WAYNE MERLIN OLSEN D.C.

Table of content: MISS SAMANTHA NISI (NPI 1154812469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497764914 NPI number — DR. WAYNE MERLIN OLSEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSEN
Provider First Name:
WAYNE
Provider Middle Name:
MERLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497764914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-5981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-298-9190
Provider Business Mailing Address Fax Number:
801-298-2451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-5981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-298-9190
Provider Business Practice Location Address Fax Number:
801-298-2451
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4821942-1202 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 62884 . This is a "PUBLIC EMPLOYEES HEALTH P" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZZZZZ . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 691629 . This is a "DESERET MUTUAL BENEFITS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 48219421200001 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107003489101 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 48219421200001 . This is a "REGENCE BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00063641 . This is a "PALMETTO" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com