Healthcare Provider Details

I. General information

NPI: 1235478249
Provider Name (Legal Business Name): 17TH STREET OLIVEIRA CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 17TH ST
SAN FRANCISCO CA
94114-2021
US

IV. Provider business mailing address

3705 17TH ST
SAN FRANCISCO CA
94114-2021
US

V. Phone/Fax

Practice location:
  • Phone: 504-453-6244
  • Fax: 415-863-2225
Mailing address:
  • Phone: 504-453-6244
  • Fax: 415-863-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32406
License Number StateCA

VIII. Authorized Official

Name: DR. RODRIGO TAVORA OLIVEIRA
Title or Position: CEO
Credential: DC
Phone: 504-453-6244