Provider Demographics
NPI:1336254069
Name:OBERLE, STEVEN HENRY (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HENRY
Last Name:OBERLE
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LIELMANIS AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5613
Mailing Address - Country:US
Mailing Address - Phone:850-881-5240
Mailing Address - Fax:
Practice Address - Street 1:113 LIELMANIS AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5613
Practice Address - Country:US
Practice Address - Phone:850-881-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11563111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004196251Medicaid
11114960OtherMULTIPLAN
133000OtherCONNECTICARE
7082345OtherAETNA NON HMO
P2106201OtherOXFORD
2V5763OtherHEALTHNET
061554676OtherUNITED
1793417002OtherCIGNA
050001330CT01OtherANTHEM BC AND BS
3523026OtherAETNA
133000OtherCONNECTICARE
350001029Medicare ID - Type Unspecified