Provider Demographics
NPI:1720158256
Name:OLIVER, CLIFFORD C III (DC RN)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:C
Last Name:OLIVER
Suffix:III
Gender:M
Credentials:DC RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:STE A102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:858-272-2333
Mailing Address - Fax:858-272-2335
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STE A102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-272-2333
Practice Address - Fax:858-272-2335
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADC14179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14179Medicare ID - Type Unspecified