Provider Demographics
NPI:1700214061
Name:OLVER, OTRA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:OTRA
Middle Name:LEE
Last Name:OLVER
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 1:501 E KATELLA AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4906
Mailing Address - Country:US
Mailing Address - Phone:408-202-9796
Mailing Address - Fax:
Practice Address - Street 1:29050 S WESTERN AVE STE 153
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0821
Practice Address - Country:US
Practice Address - Phone:310-519-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor