Provider Demographics
NPI:1093944621
Name:OLIVER, JOHNATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:
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 1:1550 OLD HENDERSON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3696
Mailing Address - Country:US
Mailing Address - Phone:614-725-5336
Mailing Address - Fax:614-725-5337
Practice Address - Street 1:1355 KING AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2279
Practice Address - Country:US
Practice Address - Phone:614-725-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor