Provider Demographics
NPI:1376613794
Name:OSTLER, DUANE (DC)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:OSTLER
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 1:2741 W SOUTHERN AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4255
Mailing Address - Country:US
Mailing Address - Phone:602-438-8722
Mailing Address - Fax:
Practice Address - Street 1:2741 W SOUTHERN AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4255
Practice Address - Country:US
Practice Address - Phone:602-438-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU05996Medicare UPIN
Z-DC4863Medicare ID - Type Unspecified