=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407035785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVE OLYNYK DBA RENTON CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2007
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 FACTORY AVE N STE 2A
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-228-2824
-----------------------------------------------------
Fax | 425-228-6956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 FACTORY AVE N STE 2A
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-228-2824
-----------------------------------------------------
Fax | 425-228-6956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVE MARK OLYNYK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 425-228-2824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00003464
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA00011739
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHOOOO3282
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------