Healthcare Provider Details

I. General information

NPI: 1619195450
Provider Name (Legal Business Name): MICHELLE ELLEN OLIVER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 GREENBRIAR DR STE B
SPRINGFIELD IL
62704-7433
US

IV. Provider business mailing address

2908 GREENBRIAR DR STE B
SPRINGFIELD IL
62704-7433
US

V. Phone/Fax

Practice location:
  • Phone: 217-720-8933
  • Fax: 855-956-0223
Mailing address:
  • Phone: 217-720-8933
  • Fax: 855-956-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008294
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038-008294
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number038-008294
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: