Provider Demographics
NPI:1831386820
Name:ORSBORN, JOHN W (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ORSBORN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 N 17TH ST W
Mailing Address - Street 2:11
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-6826
Mailing Address - Country:US
Mailing Address - Phone:941-545-2445
Mailing Address - Fax:
Practice Address - Street 1:3653 CORTEZ RD W
Practice Address - Street 2:STE 120
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3168
Practice Address - Country:US
Practice Address - Phone:941-545-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist