Provider Demographics
NPI:1063290146
Name:MUZONES, OLIVIA GRACE (DC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:MUZONES
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 1:2775 MESA VERDE DR E APT B105
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4905
Mailing Address - Country:US
Mailing Address - Phone:847-867-9918
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE U3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4627
Practice Address - Country:US
Practice Address - Phone:847-867-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty