Provider Demographics
NPI:1104043124
Name:OLIVERIUS, SHANE LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:LOUIS
Last Name:OLIVERIUS
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 1:12404 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1155
Mailing Address - Country:US
Mailing Address - Phone:913-669-0970
Mailing Address - Fax:
Practice Address - Street 1:9150 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1364
Practice Address - Country:US
Practice Address - Phone:913-385-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor