Provider Demographics
NPI:1699829242
Name:OTNESS, ARNE DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ARNE
Middle Name:DEAN
Last Name:OTNESS
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 1:1500 S ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6512
Mailing Address - Country:US
Mailing Address - Phone:503-738-3331
Mailing Address - Fax:503-738-3332
Practice Address - Street 1:1500 S ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6512
Practice Address - Country:US
Practice Address - Phone:503-738-3331
Practice Address - Fax:503-738-3332
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
67977Medicare UPIN
R0000QGCCBMedicare ID - Type Unspecified