Provider Demographics
NPI:1619191871
Name:OSTROW, CLIFFORD DARRYL (DC)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:DARRYL
Last Name:OSTROW
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 1:72 DARE LANE
Mailing Address - Street 2:
Mailing Address - City:DALLS
Mailing Address - State:GA
Mailing Address - Zip Code:30157
Mailing Address - Country:US
Mailing Address - Phone:770-443-3349
Mailing Address - Fax:
Practice Address - Street 1:500 NATHAN DEAN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:770-445-6919
Practice Address - Fax:770-445-5659
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
352CFDHMedicare ID - Type Unspecified
U69557Medicare UPIN