Provider Demographics
NPI:1396270757
Name:OSTERBERG, SANDRA TRESSA (DC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:TRESSA
Last Name:OSTERBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17933 NW EVERGREEN PAKWAY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7661
Mailing Address - Country:US
Mailing Address - Phone:503-828-9265
Mailing Address - Fax:
Practice Address - Street 1:17933 NW EVERGREEN PKWY
Practice Address - Street 2:SUITE 285
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7659
Practice Address - Country:US
Practice Address - Phone:503-828-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor