Provider Demographics
NPI:1538153473
Name:OLIVETTI, MARK T (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:OLIVETTI
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 1:3690 VARTAN WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9438
Mailing Address - Country:US
Mailing Address - Phone:717-657-3330
Mailing Address - Fax:717-657-1221
Practice Address - Street 1:3690 VARTAN WAY
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9438
Practice Address - Country:US
Practice Address - Phone:717-657-3330
Practice Address - Fax:717-657-1221
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOL1653342OtherHIGHMARK
PA50045532OtherCBC
PA085417Medicare ID - Type UnspecifiedMEDICARE