Provider Demographics
NPI:1912623828
Name:OSTEEN, ASHLEY DIANE (DC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DIANE
Last Name:OSTEEN
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 1:4733 SW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-6201
Mailing Address - Country:US
Mailing Address - Phone:386-853-0007
Mailing Address - Fax:
Practice Address - Street 1:4733 SW 78TH CT
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-6201
Practice Address - Country:US
Practice Address - Phone:386-853-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor