Provider Demographics
NPI:1649339904
Name:OLIVEAU, ANDREA M (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:OLIVEAU
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 1:520 N VENTU PARK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2708
Mailing Address - Country:US
Mailing Address - Phone:818-661-6369
Mailing Address - Fax:
Practice Address - Street 1:44725 10TH ST W
Practice Address - Street 2:SUITE 270
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3033
Practice Address - Country:US
Practice Address - Phone:661-945-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98841Medicare UPIN
CADC28582Medicare PIN