Basic Information
| Provider Information | |||||||||
| NPI: | 1255683108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSBORNE | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | CARTERET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070081536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325412233 | ||||||||
| FaxNumber: | 7325412237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | CARTERET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070081536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325412233 | ||||||||
| FaxNumber: | 7325412237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 38MC00704400 | NJ | Y | Chiropractic Providers | Chiropractor |
No ID Information.