Provider Demographics
NPI:1710102066
Name:CASHMORE, OLIVIA BRESSY (DC, CCN)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:BRESSY
Last Name:CASHMORE
Suffix:
Gender:F
Credentials:DC, CCN
Other - Prefix:DR
Other - First Name:OLIVIA
Other - Middle Name:HELENE
Other - Last Name:BRESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6106 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7274
Mailing Address - Country:US
Mailing Address - Phone:262-220-8500
Mailing Address - Fax:
Practice Address - Street 1:3601 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1695
Practice Address - Country:US
Practice Address - Phone:262-220-8500
Practice Address - Fax:847-278-5588
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010095111NP0017X, 111NN1001X, 111NR0400X
WI5085111NN1001X, 111NP0017X, 111NR0400X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No133N00000XDietary & Nutritional Service ProvidersNutritionist