Provider Demographics
NPI:1750303186
Name:OLIVERIO, ANTHONY B (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:OLIVERIO
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 1:912 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4444
Mailing Address - Country:US
Mailing Address - Phone:352-563-5055
Mailing Address - Fax:352-563-5069
Practice Address - Street 1:912 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4444
Practice Address - Country:US
Practice Address - Phone:352-563-5055
Practice Address - Fax:352-563-5069
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381129800Medicaid
FL350043972OtherRAILROAD MEDICARE
FL55797OtherBLUE CROSS/ BLUE SHIELD
FL381129800Medicaid
E1290ZMedicare PIN