Provider Demographics
NPI:1629236492
Name:OSBORN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:OSBORN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:DION
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-351-2110
Mailing Address - Street 1:2605 DANVILLE ROAD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603
Mailing Address - Country:US
Mailing Address - Phone:256-351-2110
Mailing Address - Fax:256-351-2109
Practice Address - Street 1:2605 DANVILLE ROAD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-351-2110
Practice Address - Fax:256-351-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1897111N00000X
AL1965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU83644Medicare UPIN