Healthcare Provider Details

I. General information

NPI: 1336449362
Provider Name (Legal Business Name): CHARLES OLIVERI, D.C. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 SE OCEAN BLVD
STUART FL
34996-3302
US

IV. Provider business mailing address

1990 SE OCEAN BLVD
STUART FL
34996-3302
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-9597
  • Fax: 772-223-1110
Mailing address:
  • Phone: 772-223-9597
  • Fax: 772-223-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6517
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES OLIVERI
Title or Position: OWNER
Credential: D.C.
Phone: 772-223-9597