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NPI Code Detail

MEDICARE: MADISON RAE OLIVAREZ DC, ATC

MEDICARE:   MADISON RAE OLIVAREZ  DC, ATC
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
1111N00000XChiropractor15073TX
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1962948497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON RAE OLIVAREZ DC, ATC
Provider Business Mailing Address
First Line : 1012 CAMPBELL RD
Second Line :
City : HOUSTON
State : TX
Zip : 77055-7408
Country : US
Telephone Number : 713-468-3155
Fax Number :
Provider Business Practice Location Address
First Line : 1012 CAMPBELL RD
Second Line :
City : HOUSTON
State : TX
Zip : 77055-7408
Country : US
Telephone Number : 713-468-3155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2017
Last Update Date : 02/17/2023

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Directions to “ MADISON RAE OLIVAREZ DC, ATC” Practice Location

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