Healthcare Provider Details

I. General information

NPI: 1710102066
Provider Name (Legal Business Name): OLIVIA BRESSY CASHMORE DC, CCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. OLIVIA HELENE BRESSY

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 30TH AVE SUITE 101
KENOSHA WI
53144-1695
US

IV. Provider business mailing address

6106 115TH AVE
KENOSHA WI
53142-7274
US

V. Phone/Fax

Practice location:
  • Phone: 262-220-8500
  • Fax: 847-278-5588
Mailing address:
  • Phone: 262-220-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number038010095
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038010095
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5085
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number5085
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038010095
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5085
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: