Provider Demographics
NPI:1710203823
Name:OERTEL, SAMUEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:OERTEL
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 1:7100 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3688
Mailing Address - Country:US
Mailing Address - Phone:505-883-5858
Mailing Address - Fax:505-883-0010
Practice Address - Street 1:7100 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3688
Practice Address - Country:US
Practice Address - Phone:505-883-5858
Practice Address - Fax:505-883-0010
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor