Provider Demographics
NPI:1689843278
Name:OSENGA, ADAM S (DC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:S
Last Name:OSENGA
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 1:4332 FLAGSTAFF CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4416
Mailing Address - Country:US
Mailing Address - Phone:260-696-0959
Mailing Address - Fax:260-969-0052
Practice Address - Street 1:6633 E STATE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7035
Practice Address - Country:US
Practice Address - Phone:260-696-0959
Practice Address - Fax:260-969-0052
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2022-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3886111N00000X
IN08002385A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9312811OtherPTAN
IN221280OtherPTAN
OH2829701Medicaid
INU65954Medicare UPIN
OH2829701Medicaid