Healthcare Provider Details

I. General information

NPI: 1962524959
Provider Name (Legal Business Name): GREGORY A OBERG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 WILLIAMS BLVD SUITE A
RICHLAND WA
99354-3207
US

IV. Provider business mailing address

604 WILLIAMS BLVD SUITE A
RICHLAND WA
99354-3207
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-0631
  • Fax: 509-946-0632
Mailing address:
  • Phone: 509-946-0631
  • Fax: 509-946-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00000995
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH00000995
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: