MEDICARE: DR. SEAN MICHAEL OSTLUND D.C., M.S.E.S.S.

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	111NS0005X	Sports Physician Chiropractor	5689	OR

General Provider Information

NPI Number	:	1780059873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN MICHAEL OSTLUND D.C., M.S.E.S.S.

Provider Business Mailing Address
First Line	:	1750 BLANKENSHIP RD
Second Line	:	STE 295
City	:	WEST LINN
State	:	OR
Zip	:	97068-5104
Country	:	US
Telephone Number	:	503-344-4378
Fax Number	:	503-334-3604

Provider Business Practice Location Address
First Line	:	10355 NW GLENCOE RD
Second Line	:	SUITE B
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8244
Country	:	US
Telephone Number	:	503-647-9944
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	11/16/2016

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