MEDICARE: ISMAEL ADOLFO OLIVARES 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	X006420-1	NY

General Provider Information

NPI Number	:	1619363991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAEL ADOLFO OLIVARES DC

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-0367
Country	:	US
Telephone Number	:	585-271-7750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 GILBERT MILLS RD
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-8802
Country	:	US
Telephone Number	:	585-271-7750
Fax Number	:

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

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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