Provider Demographics
NPI:1346372596
Name:SPIVAK, OLGA (DC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SPIVAK
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 1:1580 SHORELINE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5010
Mailing Address - Country:US
Mailing Address - Phone:954-589-8359
Mailing Address - Fax:954-456-6726
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 901
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4726
Practice Address - Country:US
Practice Address - Phone:954-456-7777
Practice Address - Fax:954-456-6726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7942111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation