Provider Demographics
NPI:1104068899
Name:OLSEN, ANTHONY STEPHEN (LAC, MS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:STEPHEN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:LAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 KILAUEA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5308
Mailing Address - Country:US
Mailing Address - Phone:808-384-5159
Mailing Address - Fax:
Practice Address - Street 1:4418 WEEPING SPRUCE CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4443
Practice Address - Country:US
Practice Address - Phone:805-637-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI728171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist