Healthcare Provider Details

I. General information

NPI: 1184815052
Provider Name (Legal Business Name): OSTEOPATHIC CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 ADAMS BLVD
BOULDER CITY NV
89005-2235
US

IV. Provider business mailing address

PO BOX 60553
BOULDER CITY NV
89006-0553
US

V. Phone/Fax

Practice location:
  • Phone: 702-249-9351
  • Fax: 702-293-0845
Mailing address:
  • Phone: 702-249-9351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1190
License Number StateNV

VIII. Authorized Official

Name: DR. SHARON M. GUSTOWSKI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 702-249-9351