Healthcare Provider Details

I. General information

NPI: 1558811984
Provider Name (Legal Business Name): KEVIN DEWAYNE OSBORNE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTMORELAND OFFICE PARK
DUNBAR WV
25064-2725
US

IV. Provider business mailing address

100 WESTMORELAND OFFICE PARK
DUNBAR WV
25064-2725
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-5068
  • Fax:
Mailing address:
  • Phone: 304-768-5068
  • Fax: 304-768-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1007
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: