Provider Demographics
NPI:1992922322
Name:OLESTON, CARRIE BETH (DC)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:BETH
Last Name:OLESTON
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 1:6575 GUNN HWY.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-443-0504
Mailing Address - Fax:813-443-5740
Practice Address - Street 1:6575 GUNN HWY.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-443-0504
Practice Address - Fax:813-443-5740
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9314111N00000X
FLCH9314111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382216800Medicaid