Provider Demographics
NPI:1437179348
Name:OSTERBERG, FREDERICK ALLARD (DC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ALLARD
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 1:718 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2605
Mailing Address - Country:US
Mailing Address - Phone:717-244-8504
Mailing Address - Fax:717-244-5401
Practice Address - Street 1:718 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2605
Practice Address - Country:US
Practice Address - Phone:717-244-8504
Practice Address - Fax:717-244-5401
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001370L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU02098Medicare UPIN