Provider Demographics
NPI:1235299751
Name:OSTENSON, ROY M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:M
Last Name:OSTENSON
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 1:2425 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3110
Mailing Address - Country:US
Mailing Address - Phone:920-731-0715
Mailing Address - Fax:920-731-8673
Practice Address - Street 1:2425 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3110
Practice Address - Country:US
Practice Address - Phone:920-731-0715
Practice Address - Fax:920-731-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1369111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation