Provider Demographics
NPI:1225654379
Name:OLIVER, MIRANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3222
Mailing Address - Country:US
Mailing Address - Phone:479-806-6912
Mailing Address - Fax:
Practice Address - Street 1:5518 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3222
Practice Address - Country:US
Practice Address - Phone:479-551-3434
Practice Address - Fax:479-551-2337
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor