Provider Demographics
NPI:1467664102
Name:EDWARD P. OLFF CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:EDWARD P. OLFF CHIROPRACTIC INC.
Other - Org Name:BLACKSTONE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLFF
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:559-449-9777
Mailing Address - Street 1:5665 N BLACKSTONE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5000
Mailing Address - Country:US
Mailing Address - Phone:559-449-9777
Mailing Address - Fax:
Practice Address - Street 1:5665 N BLACKSTONE AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5000
Practice Address - Country:US
Practice Address - Phone:559-449-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0185750Medicare ID - Type Unspecified
CAU42766Medicare UPIN