Provider Demographics
NPI:1760606354
Name:OLIVER, REBECCA J (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:F
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 369
Mailing Address - Street 2:694 PORTSMOUTH AVE.
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-0369
Mailing Address - Country:US
Mailing Address - Phone:603-436-1811
Mailing Address - Fax:
Practice Address - Street 1:694 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2227
Practice Address - Country:US
Practice Address - Phone:603-436-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6610602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7677Medicare ID - Type Unspecified