Provider Demographics
NPI:1770612418
Name:ULBERG, JERI LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:LYNN
Last Name:ULBERG
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 1:901 GREENWICH DR.
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-449-2646
Mailing Address - Fax:805-449-2647
Practice Address - Street 1:901 GREENWICH DR.
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-449-2646
Practice Address - Fax:805-449-2647
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25942111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0259420OtherBLUE SHIELD
CAV00218Medicare UPIN
CADC25942Medicare ID - Type Unspecified