Provider Demographics
NPI:1194851287
Name:OLLIS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:OLLIS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:OLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-534-9426
Mailing Address - Street 1:1045 THOMAS JEFFERSON RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4642
Mailing Address - Country:US
Mailing Address - Phone:434-534-9426
Mailing Address - Fax:434-534-9428
Practice Address - Street 1:1045 THOMAS JEFFERSON RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4642
Practice Address - Country:US
Practice Address - Phone:434-534-9426
Practice Address - Fax:434-534-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X274O01Medicare PIN