Provider Demographics
NPI:1497763387
Name:OSBORNE, DANIEL J (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1334 N WHITMAN LANE
Mailing Address - Street 2:#100
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7594
Mailing Address - Country:US
Mailing Address - Phone:509-922-1810
Mailing Address - Fax:509-922-1823
Practice Address - Street 1:1334 N WHITMAN
Practice Address - Street 2:#100
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7594
Practice Address - Country:US
Practice Address - Phone:509-922-1810
Practice Address - Fax:509-922-1823
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8805687Medicare PIN
V00611Medicare UPIN
WA8805687Medicare PIN
WAV00611Medicare UPIN