Provider Demographics
NPI:1134324809
Name:OSIWALA, JAMES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:OSIWALA
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 1:32004 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1419
Mailing Address - Country:US
Mailing Address - Phone:586-296-1111
Mailing Address - Fax:586-296-3664
Practice Address - Street 1:32004 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1419
Practice Address - Country:US
Practice Address - Phone:586-296-1111
Practice Address - Fax:586-296-3664
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO5283OtherBCBS PROVIDER NUMBER
MIOEO5283OtherBCBS PROVIDER NUMBER