Provider Demographics
NPI:1619195450
Name:OLIVER, MICHELLE ELLEN (DC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELLEN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 MONTEGA DR STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7011
Mailing Address - Country:US
Mailing Address - Phone:217-720-8933
Mailing Address - Fax:855-956-0223
Practice Address - Street 1:2609 MONTEGA DR STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7011
Practice Address - Country:US
Practice Address - Phone:217-720-8933
Practice Address - Fax:855-956-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008294111NP0017X, 111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL75744Medicare PIN
IL569590Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILU71142Medicare UPIN