Individual provider Active NPI

Samuel Oklesh, D.C.

  • Chiropractor
  • Lakeland, FL
National Provider Identifier
1750572376
Registry record updated Sep 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH6363 Issued in FL
Practice address
5516 US Highway 98 N
Lakeland, FL 33809-3101
Phone
(863) 858-3993
Fax
(863) 858-7398
NPI assigned
Aug 8, 2007
Last updated
Sep 26, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH6363 FL Primary

Addresses

Primary practice location

5516 US Highway 98 N
Lakeland, FL 33809-3101

Mailing address

1130 N Lake Parker Ave
Apt. E132
Lakeland, FL 33805-4756
Phone (863) 409-1464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH6363FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Newberry Clinic of Chiropractic PA Inc Chiropractor PastSince Sep 22, 1995 Accepting new patients
North Lakeland Pain & Trauma Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190764800000",
    "number": "1750572376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N LAKE PARKER AVE",
            "address_2": "APT. E132",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054756",
            "telephone_number": "863-409-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5516 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338093101",
            "telephone_number": "863-858-3993",
            "fax_number": "863-858-7398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKLESH",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-08",
        "last_updated": "2007-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.