Provider Demographics
NPI:1841276680
Name:OSBORN, TIMOTHY MARC (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARC
Last Name:OSBORN
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 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1111 W TOWN AND COUNTRY RD
Practice Address - Street 2:21
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4615
Practice Address - Country:US
Practice Address - Phone:714-541-2225
Practice Address - Fax:714-677-1664
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23344OtherCHIROPRACTIC LICENSE
CADC0233440OtherBLUE SHIELD PIN