Provider Demographics
NPI:1730247990
Name:OLSEN, MARTIN NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:NEIL
Last Name:OLSEN
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 1:6435 CAMINITO BLYTHEFIELD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5851
Mailing Address - Country:US
Mailing Address - Phone:858-454-4557
Mailing Address - Fax:858-454-3847
Practice Address - Street 1:6435 CAMINITO BLYTHEFIELD
Practice Address - Street 2:SUITE D
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5851
Practice Address - Country:US
Practice Address - Phone:858-454-4557
Practice Address - Fax:858-454-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20729Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER