Provider Demographics
NPI:1326234642
Name:NEUROMUSCULAR INSTITUTE, LLC
Entity Type:Organization
Organization Name:NEUROMUSCULAR INSTITUTE, LLC
Other - Org Name:OBERLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-364-6552
Mailing Address - Street 1:917 PARKVIEW DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-3228
Mailing Address - Country:US
Mailing Address - Phone:337-364-6552
Mailing Address - Fax:
Practice Address - Street 1:917 PARKVIEW DR
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-3228
Practice Address - Country:US
Practice Address - Phone:337-364-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4B945Medicare PIN
LAU83787Medicare UPIN