Provider Demographics
NPI:1487862306
Name:OLIVER CHIROPRACTIC ASSOC P.A.
Entity Type:Organization
Organization Name:OLIVER CHIROPRACTIC ASSOC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-778-8996
Mailing Address - Street 1:120 E CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1625
Mailing Address - Country:US
Mailing Address - Phone:856-778-8996
Mailing Address - Fax:856-778-5705
Practice Address - Street 1:120 E CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1625
Practice Address - Country:US
Practice Address - Phone:856-778-8996
Practice Address - Fax:856-778-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00190700111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092496UD3Medicare ID - Type Unspecified