Provider Demographics
NPI:1891081600
Name:OS CORP
Entity Type:Organization
Organization Name:OS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:HAAZEN GERARDUS
Authorized Official - Last Name:VANDEN WYNBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-233-1866
Mailing Address - Street 1:214 5TH ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6202
Mailing Address - Country:US
Mailing Address - Phone:641-512-1582
Mailing Address - Fax:515-233-9513
Practice Address - Street 1:214 5TH ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6202
Practice Address - Country:US
Practice Address - Phone:641-512-1582
Practice Address - Fax:515-233-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2197Medicare PIN