Provider Demographics
NPI:1104966795
Name:OSLAND, LOGAN THOR (DC)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:THOR
Last Name:OSLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 TELEGRAPH RD STE A-4
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4254
Mailing Address - Country:US
Mailing Address - Phone:805-644-4937
Mailing Address - Fax:805-644-9096
Practice Address - Street 1:5550 TELEGRAPH RD STE A-4
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4254
Practice Address - Country:US
Practice Address - Phone:805-644-4937
Practice Address - Fax:805-644-9096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23939OtherCHIROPRACTOR