Provider Demographics
NPI:1447309620
Name:OBERG CHIROPRACTIC
Entity type:Organization
Organization Name:OBERG CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-946-0631
Mailing Address - Street 1:604 WILLIAMS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3207
Mailing Address - Country:US
Mailing Address - Phone:509-946-0631
Mailing Address - Fax:509-946-0632
Practice Address - Street 1:604 WILLIAMS BLVD STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3207
Practice Address - Country:US
Practice Address - Phone:509-946-0631
Practice Address - Fax:509-946-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000995111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA03695OtherL & I
WA03695OtherL & I
WAAB09502Medicare Oscar/Certification