Provider Demographics
NPI:1619363991
Name:OLIVARES, ISMAEL ADOLFO (DC)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:ADOLFO
Last Name:OLIVARES
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-0367
Mailing Address - Country:US
Mailing Address - Phone:585-271-7750
Mailing Address - Fax:
Practice Address - Street 1:1178 GILBERT MILLS RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-8802
Practice Address - Country:US
Practice Address - Phone:585-271-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006420-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor