Provider Demographics
NPI:1598434524
Name:OLIVERAS, MIGUEL JR (DC)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:OLIVERAS
Suffix:JR
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 1:4118 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2510
Mailing Address - Country:US
Mailing Address - Phone:646-753-0798
Mailing Address - Fax:
Practice Address - Street 1:13854 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4210
Practice Address - Country:US
Practice Address - Phone:703-670-9935
Practice Address - Fax:703-670-9939
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor