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General NPI Number Information
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NPI Number | 1497771422
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Entity Type | Individual
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Provider Name | MARK ALLEN OSBORNE DC
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 1121 E SE LOOP 323 STE 102
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City | TYLER
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State | TX
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Zip | 75701-9660
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Country | US
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Telephone | 903-561-1071
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Fax | 903-561-6841
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Provider Business Mailing Address
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Address Line | 13706 COUNTY ROAD 291
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City | TYLER
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State | TX
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Zip | 75707-4844
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Country | US
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Telephone | 903-253-5295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9325
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License Number State | TX
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