Provider Demographics
NPI:1629850797
Name:OSBORNE, CODI NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:CODI
Middle Name:NICOLE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N MURRAY BLVD APT 722
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-1156
Mailing Address - Country:US
Mailing Address - Phone:304-542-3186
Mailing Address - Fax:
Practice Address - Street 1:175 N MURRAY BLVD APT 722
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-1156
Practice Address - Country:US
Practice Address - Phone:304-542-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36759111N00000X
COCHR0008739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor