Provider Demographics
NPI:1134136914
Name:OSBORN, CHARLES RAY (MD DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2597
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75168-8597
Mailing Address - Country:US
Mailing Address - Phone:972-938-7757
Mailing Address - Fax:972-938-0018
Practice Address - Street 1:201 FERRIS AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4824
Practice Address - Country:US
Practice Address - Phone:972-938-7757
Practice Address - Fax:972-938-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4497111NX0100X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
T15127Medicare UPIN
TX601757Medicare ID - Type Unspecified