Provider Demographics
NPI:1215002639
Name:OSTERBERG, BRIAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:OSTERBERG
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 1:3030 US HIGHWAY 141
Mailing Address - Street 2:
Mailing Address - City:POUND
Mailing Address - State:WI
Mailing Address - Zip Code:54161-9720
Mailing Address - Country:US
Mailing Address - Phone:920-897-3554
Mailing Address - Fax:
Practice Address - Street 1:3030 US HIGHWAY 141
Practice Address - Street 2:
Practice Address - City:POUND
Practice Address - State:WI
Practice Address - Zip Code:54161-9720
Practice Address - Country:US
Practice Address - Phone:920-897-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI621623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor