Healthcare Provider Details

I. General information

NPI: 1447288527
Provider Name (Legal Business Name): RONALD EDGAR OLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18687 MAIN STREET SUITE D1
GROVELAND CA
95321
US

IV. Provider business mailing address

PO BOX 845
GROVELAND CA
95321-0845
US

V. Phone/Fax

Practice location:
  • Phone: 209-962-0662
  • Fax: 209-962-0455
Mailing address:
  • Phone: 209-962-0662
  • Fax: 877-422-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC10746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: