Provider Demographics
NPI:1679644405
Name:OSTERHOUT, STEVEN TODD (DC,CCN)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:TODD
Last Name:OSTERHOUT
Suffix:
Gender:M
Credentials:DC,CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 OAKLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1116
Mailing Address - Country:US
Mailing Address - Phone:269-324-4143
Mailing Address - Fax:269-324-0755
Practice Address - Street 1:5717 OAKLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1116
Practice Address - Country:US
Practice Address - Phone:269-324-4143
Practice Address - Fax:269-324-0755
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C91557OtherBCBS
MI0C91557OtherBCBS
MI0P59420001Medicare PIN