Provider Demographics
NPI:1053996082
Name:SERVIN, OLIVER (DC)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:SERVIN
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 1:3850 E LOHMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8288
Mailing Address - Country:US
Mailing Address - Phone:575-521-0793
Mailing Address - Fax:575-532-1607
Practice Address - Street 1:3850 E LOHMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8288
Practice Address - Country:US
Practice Address - Phone:575-521-0793
Practice Address - Fax:575-532-1607
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty