Provider Demographics
NPI:1407843550
Name:OLIVERI, CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:OLIVERI
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 1:626 SE CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3970
Mailing Address - Country:US
Mailing Address - Phone:772-223-9597
Mailing Address - Fax:772-223-1110
Practice Address - Street 1:626 SE CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3970
Practice Address - Country:US
Practice Address - Phone:772-223-9597
Practice Address - Fax:772-223-1110
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6517111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381453000Medicaid
FL55334AMedicare ID - Type Unspecified
FL381453000Medicaid