Healthcare Provider Details

I. General information

NPI: 1083820013
Provider Name (Legal Business Name): OLMSTED CHIROPRACTIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 LAKE MARIAM BLVD
WINTER HAVEN FL
33884-3815
US

IV. Provider business mailing address

327 LAKE MARIAM BLVD
WINTER HAVEN FL
33884-3815
US

V. Phone/Fax

Practice location:
  • Phone: 863-585-4440
  • Fax:
Mailing address:
  • Phone: 863-585-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8288
License Number StateFL

VIII. Authorized Official

Name: DR. MELISSA G. OLMSTED
Title or Position: OWNER
Credential: D.C.
Phone: 863-585-4440