Provider Demographics
NPI:1508042136
Name:OLIVA, LEE EMMANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:EMMANUEL
Last Name:OLIVA
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 1:15865 GALE AVE
Mailing Address - Street 2:#D
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1643
Mailing Address - Country:US
Mailing Address - Phone:626-233-9426
Mailing Address - Fax:
Practice Address - Street 1:15865 GALE AVE
Practice Address - Street 2:#D
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1643
Practice Address - Country:US
Practice Address - Phone:626-233-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23937111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist