Provider Demographics
NPI:1558811984
Name:OSBORNE, KEVIN DEWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DEWAYNE
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 1:100 WESTMORELAND OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2725
Mailing Address - Country:US
Mailing Address - Phone:304-768-5068
Mailing Address - Fax:304-768-6251
Practice Address - Street 1:100 WESTMORELAND OFFICE PARK
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2725
Practice Address - Country:US
Practice Address - Phone:304-768-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor