Healthcare Provider Details

I. General information

NPI: 1750380366
Provider Name (Legal Business Name): HEALTH CHOICE OF OLIVIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W LINCOLN AVE
OLIVIA MN
56277-1272
US

IV. Provider business mailing address

1325 W LINCOLN AVE
OLIVIA MN
56277-1272
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-1253
  • Fax: 320-523-1572
Mailing address:
  • Phone: 320-523-1253
  • Fax: 320-523-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4314
License Number StateMN

VIII. Authorized Official

Name: MS. JENNIFER ELIZABETH ROBIDEAU
Title or Position: DR. ROBIDEA- PRESIDENT
Credential: D.C.
Phone: 320-523-1253