Provider Demographics
NPI:1619046802
Name:SCHOBERT, PHILLIP DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DANIEL
Last Name:SCHOBERT
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:PO BOX 1953
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-1953
Mailing Address - Country:US
Mailing Address - Phone:907-443-5550
Mailing Address - Fax:
Practice Address - Street 1:113 E FRONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-9800
Practice Address - Country:US
Practice Address - Phone:907-443-7477
Practice Address - Fax:907-443-7487
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0416Medicaid
U32087Medicare UPIN
AK160453Medicare ID - Type Unspecified