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General NPI Number Information
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NPI Number | 1366786899
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Entity Type | Organization
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Legal Business Name | OSAGE SPORTS & FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 415 MARKET ST
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City | OSAGE CITY
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State | KS
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Zip | 66523-1155
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Country | US
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Telephone | 785-528-2608
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Fax |
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Provider Business Mailing Address
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Address Line | 415 MARKET ST
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City | OSAGE CITY
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State | KS
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Zip | 66523-1155
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Country | US
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Telephone | 785-528-2608
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | ALEX LANDON BOSS
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Credential | D.C.
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Telephone | 785-528-2608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01-05482
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License Number State | KS
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