Healthcare Provider Details

I. General information

NPI: 1548344955
Provider Name (Legal Business Name): PAUL JOHN OSTERBAUER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 WOODLAND RD
CIRCLE PINES MN
55014-3529
US

IV. Provider business mailing address

4137 WOODLAND RD
CIRCLE PINES MN
55014-3529
US

V. Phone/Fax

Practice location:
  • Phone: 763-784-5304
  • Fax: 763-784-5349
Mailing address:
  • Phone: 763-784-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2341
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: