Provider Demographics
NPI:1023024072
Name:OSBORN, DAREN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:WAYNE
Last Name:OSBORN
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 1:2391 BRANDERMILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1985
Mailing Address - Country:US
Mailing Address - Phone:410-721-2222
Mailing Address - Fax:410-721-2437
Practice Address - Street 1:2391 BRANDERMILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1985
Practice Address - Country:US
Practice Address - Phone:410-721-2222
Practice Address - Fax:410-721-2437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007696111N00000X
MDS03811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005522654OtherBCBS PROVIDER #
ILU55602Medicare UPIN
IL0005522654OtherBCBS PROVIDER #