Provider Demographics
NPI:1497789366
Name:OSBORNE, JOHN ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:OSBORNE
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:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:501 N BARRON ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1252
Practice Address - Country:US
Practice Address - Phone:903-683-2900
Practice Address - Fax:903-683-9585
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00021427OtherMEDICARE RR
T15128Medicare UPIN
P00021427OtherMEDICARE RR
P00021427Medicare PIN