Provider Demographics
NPI:1902998545
Name:OBORNY, JEROME B (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:B
Last Name:OBORNY
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 1:104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-2101
Mailing Address - Country:US
Mailing Address - Phone:785-743-2320
Mailing Address - Fax:785-743-5264
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-2101
Practice Address - Country:US
Practice Address - Phone:785-743-2320
Practice Address - Fax:785-743-5264
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007167OtherBLUE CROSS BLUE SHIELD
KST43897Medicare UPIN