Provider Demographics
NPI:1750572376
Name:OKLESH, SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:OKLESH
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 1:1130 N LAKE PARKER AVE
Mailing Address - Street 2:APT. E132
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4756
Mailing Address - Country:US
Mailing Address - Phone:863-409-1464
Mailing Address - Fax:
Practice Address - Street 1:5516 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3101
Practice Address - Country:US
Practice Address - Phone:863-858-3993
Practice Address - Fax:863-858-7398
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22681Medicare PIN