Provider Demographics
NPI:1780059873
Name:OSTLUND, SEAN MICHAEL (DC, MSESS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:OSTLUND
Suffix:
Gender:M
Credentials:DC, MSESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 BLANKENSHIP RD
Mailing Address - Street 2:STE 295
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5104
Mailing Address - Country:US
Mailing Address - Phone:503-344-4378
Mailing Address - Fax:503-334-3604
Practice Address - Street 1:10355 NW GLENCOE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8244
Practice Address - Country:US
Practice Address - Phone:503-647-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5689111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician