Provider Demographics
NPI:1982842043
Name:OSGOOD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OSGOOD FAMILY CHIROPRACTIC LLC
Other - Org Name:LIGHTHOUSE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-223-5914
Mailing Address - Street 1:1045 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-223-5914
Mailing Address - Fax:970-223-5918
Practice Address - Street 1:1045 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FT. COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-223-5914
Practice Address - Fax:970-223-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty