Provider Demographics
NPI:1558593327
Name:OLVERA, KATHLEEN ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:OLVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:WHITMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:114 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2018
Mailing Address - Country:US
Mailing Address - Phone:248-656-6957
Mailing Address - Fax:248-656-6958
Practice Address - Street 1:114 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2018
Practice Address - Country:US
Practice Address - Phone:248-656-6957
Practice Address - Fax:248-656-6958
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor