Provider Demographics
NPI:1174573463
Name:OLIVER, BRIAN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9375
Mailing Address - Country:US
Mailing Address - Phone:989-731-4050
Mailing Address - Fax:989-731-4803
Practice Address - Street 1:970 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9375
Practice Address - Country:US
Practice Address - Phone:989-731-4050
Practice Address - Fax:989-731-4803
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4388102Medicaid
MI950F950170OtherBLUE CROSS BLUE SHIELD
MI4388102Medicaid
MI0N97020Medicare ID - Type Unspecified