Healthcare Provider Details

I. General information

NPI: 1407843550
Provider Name (Legal Business Name): CHARLES OLIVERI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 SE CENTRAL PKWY
STUART FL
34994-3970
US

IV. Provider business mailing address

626 SE CENTRAL PKWY
STUART FL
34994-3970
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 Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH 6517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: