Provider Demographics
NPI:1154320190
Name:ODBERT, NANCIE (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCIE
Middle Name:
Last Name:ODBERT
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 1:1414 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4632
Mailing Address - Country:US
Mailing Address - Phone:510-378-3658
Mailing Address - Fax:
Practice Address - Street 1:1414 EVERETT ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4632
Practice Address - Country:US
Practice Address - Phone:510-378-3658
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26790111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0267900Medicare ID - Type Unspecified