Provider Demographics
NPI:1578504239
Name:OLIVAS, RAYMOND III (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:OLIVAS
Suffix:III
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 1:1341 W ROBINHOOD DR
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5515
Mailing Address - Country:US
Mailing Address - Phone:209-474-8383
Mailing Address - Fax:209-957-1555
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:SUITE A-7
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5515
Practice Address - Country:US
Practice Address - Phone:209-474-8383
Practice Address - Fax:209-957-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0235610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor