Individual Professional Information |
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NPI
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1538153473
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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5890759740
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20041119000158
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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OLIVETTI
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Individual professional last name
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Provider First Name
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MARK
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Individual professional first name
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Provider Middle Name
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THEODOSIUS
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Individual professional middle name
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Provider Gender
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M
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The provider's gender if the provider is a person.
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Provider Credential Text
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DC
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The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
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Medical School Information |
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Medical School Name
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PALMER COLLEGE CHIROPRACTIC - DAVENPORT
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Individual professional's medical school
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Graduation Year
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2004
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Individual professional's medical school graduation year
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Primary Specialty
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CHIROPRACTIC
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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PHYSICAL MEDICINE AND REHABILITATION
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First secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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PHYSICAL MEDICINE AND REHABILITATION
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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