MEDICARE: DR. BRANDON ENRIQUE OLIVA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8469	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	606088	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1053324061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON ENRIQUE OLIVA DC

Provider Business Mailing Address
First Line	:	2128 W 34TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6003
Country	:	US
Telephone Number	:	713-682-4442
Fax Number	:	713-682-3659

Provider Business Practice Location Address
First Line	:	2128 W 34TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6003
Country	:	US
Telephone Number	:	713-682-4442
Fax Number	:	713-682-3659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/05/2011

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