MEDICARE: THERESA A OSMER PC

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	230100997	MI

General Provider Information

NPI Number	:	1841742574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESA A OSMER PC

Provider Business Mailing Address
First Line	:	4945 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546
Country	:	US
Telephone Number	:	616-200-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	4945 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3722
Country	:	US
Telephone Number	:	616-200-8606
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THERESA ANNE OSMER
Credential	:	DC
Telephone Number	:	616-200-8606

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	08/14/2023

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