Provider Demographics
NPI:1336449362
Name:CHARLES OLIVERI, D.C. P.A.
Entity Type:Organization
Organization Name:CHARLES OLIVERI, D.C. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-223-9597
Mailing Address - Street 1:1990 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3302
Mailing Address - Country:US
Mailing Address - Phone:772-223-9597
Mailing Address - Fax:772-223-1110
Practice Address - Street 1:1990 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3302
Practice Address - Country:US
Practice Address - Phone:772-223-9597
Practice Address - Fax:772-223-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350053282OtherRAILROAD MEDICARE
KY2445272OtherAETNA
FL55334OtherBLUE CROSS/BLUE OF FLORIDA
KY948552OtherHUMANA
FL55334AOtherMEDICARE
GA628367OtherUNITED HEALTHCARE
NY9614467OtherGHI