MEDICARE: DR. MATTHEW B. OSBORNE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3461	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O85YC	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1225072333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW B. OSBORNE D.C.

Provider Business Mailing Address
First Line	:	258 SOUTHTOWN CIR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571
Country	:	US
Telephone Number	:	919-569-0199
Fax Number	:	919-570-8669

Provider Business Practice Location Address
First Line	:	258 SOUTHTOWN CIRCLE
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9593
Country	:	US
Telephone Number	:	919-569-0199
Fax Number	:	919-570-8669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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