Provider Demographics
NPI:1902991227
Name:BIVOLCIC, DELENE (DC CCRD)
Entity Type:Individual
Prefix:MRS
First Name:DELENE
Middle Name:
Last Name:BIVOLCIC
Suffix:
Gender:F
Credentials:DC CCRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 TELEGRAPH AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6333 TELEGRAPH AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1359
Practice Address - Country:US
Practice Address - Phone:510-450-1144
Practice Address - Fax:510-450-1147
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC014554111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0145541Medicare ID - Type Unspecified