Provider Demographics
NPI:1497203913
Name:OSTERMAN, LACEY ANN (DC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:OSTERMAN
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 1:2709 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4917
Mailing Address - Country:US
Mailing Address - Phone:972-542-3300
Mailing Address - Fax:972-542-4311
Practice Address - Street 1:2709 VIRGINIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4917
Practice Address - Country:US
Practice Address - Phone:972-542-3300
Practice Address - Fax:972-542-4311
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor