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General NPI Number Information
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NPI Number | 1104535376
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Entity Type | Organization
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Legal Business Name | OLIVER PAIN RELIEF AND REHAB
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 1041 STERLING RD STE 106
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City | HERNDON
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State | VA
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Zip | 20170-3841
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Country | US
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Telephone | 703-904-8528
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Fax | 703-904-8529
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Provider Business Mailing Address
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Address Line | 1041 STERLING RD STE 106
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City | HERNDON
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State | VA
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Zip | 20170-3841
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Country | US
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Telephone | 703-904-8528
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Fax | 703-904-8529
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER OLIVER
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Credential | DC
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Telephone | 703-904-8528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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