1871866236 NPI number — OLYMPIC W&C CARE CENTER INC

Table of content: (NPI 1871866236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871866236 NPI number — OLYMPIC W&C CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIC W&C CARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OLYMPIC WELLNESS AND CHIROPRACTIC CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1871866236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3109 W OLYMPIC BLVD
Provider Second Line Business Mailing Address:
C
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90006-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-387-2225
Provider Business Mailing Address Fax Number:
213-387-2011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5042 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
505
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90036-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-505-6534
Provider Business Practice Location Address Fax Number:
213-607-3214
Provider Enumeration Date:
02/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
WOO
Authorized Official Middle Name:
JIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-501-6765

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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