Provider Demographics
NPI:1235687898
Name:OSORIO, ALEX SAMUEL (DC)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:SAMUEL
Last Name:OSORIO
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 1:7500 NW 104TH AVE STE B200
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3373
Mailing Address - Country:US
Mailing Address - Phone:305-204-2243
Mailing Address - Fax:305-371-8966
Practice Address - Street 1:7500 NW 104TH AVE STE B200
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3373
Practice Address - Country:US
Practice Address - Phone:305-204-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor