Provider Demographics
NPI:1235200684
Name:OSTRANDER, DONALD WAYNE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:OSTRANDER
Suffix:JR
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 1:20961 S LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-5007
Mailing Address - Country:US
Mailing Address - Phone:320-634-5649
Mailing Address - Fax:
Practice Address - Street 1:1106 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2643
Practice Address - Country:US
Practice Address - Phone:320-762-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN65149 OSOtherBCBSM
MN694328400Medicaid
MN65150 OSOtherBCBSM
MN0803OtherHEALTH SERVICE MANAGEMENT
MN030701102OtherPRIMEWEST
MN694328400Medicaid