Provider Demographics
NPI:1376733725
Name:BLANCO, OLIVIO OMAR JR (DC)
Entity type:Individual
Prefix:DR
First Name:OLIVIO
Middle Name:OMAR
Last Name:BLANCO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2760 SW 97TH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2684
Mailing Address - Country:US
Mailing Address - Phone:305-552-6820
Mailing Address - Fax:305-220-6584
Practice Address - Street 1:2760 SW 97TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2684
Practice Address - Country:US
Practice Address - Phone:305-552-6820
Practice Address - Fax:305-220-6584
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2012-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH6945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor