Provider Demographics
NPI:1417092800
Name:JOSEPH, OLIVIA ANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ANNA
Last Name:JOSEPH
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 1:111 OFALLON COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7931
Mailing Address - Country:US
Mailing Address - Phone:636-978-0970
Mailing Address - Fax:
Practice Address - Street 1:111 OFALLON COMMONS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7931
Practice Address - Country:US
Practice Address - Phone:636-978-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor