Healthcare Provider Details

I. General information

NPI: 1679644405
Provider Name (Legal Business Name): STEVEN TODD OSTERHOUT D.C.,CCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 OAKLAND DR SUITE A
PORTAGE MI
49024-1116
US

IV. Provider business mailing address

5717 OAKLAND DR SUITE A
PORTAGE MI
49024-1116
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-4143
  • Fax: 269-324-0755
Mailing address:
  • Phone: 269-324-4143
  • Fax: 269-324-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: