Provider Demographics
NPI:1730784497
Name:OLYMPIC PAIN SOLUTIONS
Entity type:Organization
Organization Name:OLYMPIC PAIN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:425-774-2411
Mailing Address - Street 1:6603 220TH ST SW STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2186
Mailing Address - Country:US
Mailing Address - Phone:425-774-2411
Mailing Address - Fax:425-672-7065
Practice Address - Street 1:6603 220TH ST SW STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2186
Practice Address - Country:US
Practice Address - Phone:425-774-2411
Practice Address - Fax:425-672-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty