Provider Demographics
NPI:1477567824
Name:OSBORN, DANIEL LEE (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:OSBORN
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 1:3360 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1420
Mailing Address - Country:US
Mailing Address - Phone:616-669-6702
Mailing Address - Fax:
Practice Address - Street 1:3360 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1420
Practice Address - Country:US
Practice Address - Phone:616-669-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G05094Medicare ID - Type Unspecified
U33682Medicare UPIN