Provider Demographics
NPI:1053596650
Name:360 CHIROPRACTIC PS
Entity type:Organization
Organization Name:360 CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-923-0360
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-8310
Mailing Address - Country:US
Mailing Address - Phone:360-923-0360
Mailing Address - Fax:360-923-1360
Practice Address - Street 1:5101 LACEY BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2441
Practice Address - Country:US
Practice Address - Phone:360-923-0360
Practice Address - Fax:360-923-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602760406302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization