Healthcare Provider Details

I. General information

NPI: 1558593327
Provider Name (Legal Business Name): KATHLEEN ANN OLVERA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN WHITMORE D.C.

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W 3RD ST
ROCHESTER MI
48307-2018
US

IV. Provider business mailing address

114 W 3RD ST
ROCHESTER MI
48307-2018
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-6957
  • Fax: 248-656-6958
Mailing address:
  • Phone: 248-656-6957
  • Fax: 248-656-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: