Provider Demographics
NPI:1386886422
Name:OLIVER, CHARLES A (DC, MPT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DC, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 PROTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4231
Mailing Address - Country:US
Mailing Address - Phone:210-545-1810
Mailing Address - Fax:210-545-1811
Practice Address - Street 1:930 PROTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4231
Practice Address - Country:US
Practice Address - Phone:210-545-1810
Practice Address - Fax:210-545-1811
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11109111NR0400X
TX1125649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist