Provider Demographics
NPI:1053187971
Name:OLLER, PHILLIP (DC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:OLLER
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 1:15419 WALLISVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4634
Mailing Address - Country:US
Mailing Address - Phone:832-529-3999
Mailing Address - Fax:
Practice Address - Street 1:15419 WALLISVILLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4634
Practice Address - Country:US
Practice Address - Phone:832-529-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor