Healthcare Provider Details

I. General information

NPI: 1447246343
Provider Name (Legal Business Name): EDWARD P OLFF DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 N BLACKSTONE AVE STE 107
FRESNO CA
93710-5000
US

IV. Provider business mailing address

5665 N BLACKSTONE AVE STE 107
FRESNO CA
93710-5000
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-9777
  • Fax: 559-449-9799
Mailing address:
  • Phone: 559-449-9777
  • Fax: 559-449-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC18575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: