Provider Demographics
NPI:1205890191
Name:OBERT, GWEN MARY (DC)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:MARY
Last Name:OBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S HOOD ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3459
Mailing Address - Country:US
Mailing Address - Phone:281-331-5088
Mailing Address - Fax:281-331-7473
Practice Address - Street 1:804 S HOOD ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-3459
Practice Address - Country:US
Practice Address - Phone:281-331-5088
Practice Address - Fax:281-331-7473
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601582Medicare ID - Type Unspecified
TXT12189Medicare UPIN