Provider Demographics
NPI:1225255078
Name:OSTEEN CHIROPRACTIC
Entity Type:Organization
Organization Name:OSTEEN CHIROPRACTIC
Other - Org Name:RUSSELL B. OSTEEN CH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:OSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:985-876-5790
Mailing Address - Street 1:1025 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4026
Mailing Address - Country:US
Mailing Address - Phone:985-876-5790
Mailing Address - Fax:985-876-9371
Practice Address - Street 1:1025 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4026
Practice Address - Country:US
Practice Address - Phone:985-876-5790
Practice Address - Fax:985-876-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1954357Medicaid
LA421785413BOtherBLUE CROSS OF LA
LA5S026Medicare ID - Type Unspecified