Provider Demographics
NPI:1457487654
Name:OSMONSON, JODIE M (DC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:M
Last Name:OSMONSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1213
Mailing Address - Country:US
Mailing Address - Phone:218-435-6066
Mailing Address - Fax:218-435-6061
Practice Address - Street 1:106 1ST ST W
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1213
Practice Address - Country:US
Practice Address - Phone:218-435-6066
Practice Address - Fax:218-435-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor