Healthcare Provider Details

I. General information

NPI: 1538153473
Provider Name (Legal Business Name): MARK T OLIVETTI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 VARTAN WAY
HARRISBURG PA
17110-9438
US

IV. Provider business mailing address

3690 VARTAN WAY
HARRISBURG PA
17110-9438
US

V. Phone/Fax

Practice location:
  • Phone: 717-657-3330
  • Fax: 717-657-1221
Mailing address:
  • Phone: 717-657-3330
  • Fax: 717-657-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: