Provider Demographics
NPI:1467647107
Name:OLIVER, MICHAEL W (CH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:OLIVER
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2730
Mailing Address - Country:US
Mailing Address - Phone:785-242-8688
Mailing Address - Fax:785-242-8486
Practice Address - Street 1:225 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2247
Practice Address - Country:US
Practice Address - Phone:785-242-8688
Practice Address - Fax:785-242-8486
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00299246OtherMEDICARE RAILROAD
KSP00299246OtherMEDICARE RAILROAD