Provider Demographics
NPI:1265092928
Name:KOBERNIK OSTEOPATHY INC.
Entity type:Organization
Organization Name:KOBERNIK OSTEOPATHY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KOBERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-225-7248
Mailing Address - Street 1:10503 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98303-9753
Mailing Address - Country:US
Mailing Address - Phone:253-225-7248
Mailing Address - Fax:
Practice Address - Street 1:10503 GUTHRIE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98303-9753
Practice Address - Country:US
Practice Address - Phone:253-225-7248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-15
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care