Provider Demographics
NPI:1053324061
Name:OLIVA, BRANDON ENRIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ENRIQUE
Last Name:OLIVA
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 1:2128 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6003
Mailing Address - Country:US
Mailing Address - Phone:713-682-4442
Mailing Address - Fax:713-682-3659
Practice Address - Street 1:2128 W 34TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6003
Practice Address - Country:US
Practice Address - Phone:713-682-4442
Practice Address - Fax:713-682-3659
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606088OtherBCBS
TX606088OtherBCBS
TX609387Medicare ID - Type Unspecified