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General NPI Number Information
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NPI Number | 1053596650
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Entity Type | Organization
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Legal Business Name | 360 CHIROPRACTIC PS
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 5101 LACEY BLVD SE
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City | LACEY
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State | WA
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Zip | 98503-2441
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Country | US
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Telephone | 360-923-0360
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Fax | 360-923-1360
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Provider Business Mailing Address
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Address Line | PO BOX 8310
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City | LACEY
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State | WA
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Zip | 98509-8310
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Country | US
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Telephone | 360-923-0360
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Fax | 360-923-1360
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEFANIE MARIE OLAR
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Credential | D.C.
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Telephone | 360-923-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 602760406
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License Number State | WA
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