Provider Demographics
NPI:1760498455
Name:OSTON, JAVAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:JAVAN
Middle Name:R
Last Name:OSTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4800 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2625
Mailing Address - Country:US
Mailing Address - Phone:505-888-1795
Mailing Address - Fax:505-888-1904
Practice Address - Street 1:4800 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2625
Practice Address - Country:US
Practice Address - Phone:505-888-1795
Practice Address - Fax:505-888-1904
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300521092Medicare ID - Type UnspecifiedMED B PART PROV CLINIC #
NM343532103Medicare PIN