Provider Demographics
NPI:1275674681
Name:OTTERMAN, GREGORY T (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:OTTERMAN
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 1:13133 NW MILITARY HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1813
Mailing Address - Country:US
Mailing Address - Phone:210-308-7473
Mailing Address - Fax:210-479-2709
Practice Address - Street 1:13133 NW MILITARY HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1813
Practice Address - Country:US
Practice Address - Phone:210-308-7473
Practice Address - Fax:210-479-2709
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W9600OtherBLUECROSS BLUESHIELD
TX8W9600OtherBLUECROSS BLUESHIELD