=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336449362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES OLIVERI, D.C. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2010
-----------------------------------------------------
Last Update Date | 10/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1990 SE OCEAN BLVD
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-9597
-----------------------------------------------------
Fax | 772-223-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1990 SE OCEAN BLVD
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-9597
-----------------------------------------------------
Fax | 772-223-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHARLES OLIVERI
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 772-223-9597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH6517
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------