Provider Demographics
NPI:1720676570
Name:OSMULSKI, JACOB M (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:OSMULSKI
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:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529-0313
Mailing Address - Country:US
Mailing Address - Phone:309-645-8582
Mailing Address - Fax:
Practice Address - Street 1:509 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529-9630
Practice Address - Country:US
Practice Address - Phone:309-645-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor