Provider Demographics
NPI:1235246901
Name:OLVERD, PHILIP J (DC, RD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:OLVERD
Suffix:
Gender:M
Credentials:DC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1503
Mailing Address - Country:US
Mailing Address - Phone:412-341-4344
Mailing Address - Fax:412-341-4339
Practice Address - Street 1:400 MOUNT LEBANON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1503
Practice Address - Country:US
Practice Address - Phone:412-341-4344
Practice Address - Fax:412-341-4339
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005043L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113934Medicare ID - Type Unspecified
PAU35265Medicare UPIN