Provider Demographics
NPI:1558496802
Name:ROSHIOR, OLGA (DC)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:ROSHIOR
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 1:1749 S NAPERVILLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8192
Mailing Address - Country:US
Mailing Address - Phone:630-460-6733
Mailing Address - Fax:630-752-1222
Practice Address - Street 1:1749 S NAPERVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8192
Practice Address - Country:US
Practice Address - Phone:630-460-6733
Practice Address - Fax:630-752-1222
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232306OtherBCBS OF IL
IL707760Medicare ID - Type Unspecified
ILU85506Medicare UPIN