Provider Demographics
NPI:1033491386
Name:OLIVER, KENNETH CLAYTON (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CLAYTON
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BOVET RD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-375-2545
Mailing Address - Fax:650-655-6611
Practice Address - Street 1:177 BOVET RD.
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-375-2545
Practice Address - Fax:650-655-6611
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor