Provider Demographics
NPI:1255445078
Name:OBERT CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:OBERT CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:OBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-258-4100
Mailing Address - Street 1:427 LINCOLN WAY EAST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2213
Mailing Address - Country:US
Mailing Address - Phone:574-258-4100
Mailing Address - Fax:574-258-0477
Practice Address - Street 1:427 LINCOLN WAY EAST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2213
Practice Address - Country:US
Practice Address - Phone:574-258-4100
Practice Address - Fax:574-258-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000239248OtherBCBS
IN192450Medicare PIN