Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00000995 | WA |
N | 111NI0013X | Independent Medical Examiner | CH00000995 | WA |
NPI | 1962524959 |
---|---|
Provider Name | Dr. Gregory A Oberg |
First Address | Richland, WA 99354-3207 |
Second Address | Richland, WA 99354-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0227634 | LABOR & INDUSTRIES (01) | WA |