Provider Demographics
NPI:1639321581
Name:OLLI, REBECCA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JO
Last Name:OLLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:P.O. BOX 194
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484-0194
Mailing Address - Country:US
Mailing Address - Phone:715-687-3400
Mailing Address - Fax:
Practice Address - Street 1:223 N 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:WI
Practice Address - Zip Code:54484
Practice Address - Country:US
Practice Address - Phone:715-687-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4288-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor