Provider Demographics
NPI:1780669754
Name:OBERMEYER, DOUGLAS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:OBERMEYER
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 1:128 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-4814
Mailing Address - Country:US
Mailing Address - Phone:812-933-5757
Mailing Address - Fax:812-932-3303
Practice Address - Street 1:128 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-4814
Practice Address - Country:US
Practice Address - Phone:812-933-5757
Practice Address - Fax:812-932-3303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000253359OtherANTHEM PROVIDER ID
IN201350Medicare ID - Type Unspecified
INU79041Medicare UPIN