Provider Demographics
NPI:1215960182
Name:O'STEEN, RUSSELL B (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:B
Last Name:O'STEEN
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 1:1025 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4049
Mailing Address - Country:US
Mailing Address - Phone:985-876-5790
Mailing Address - Fax:985-876-9371
Practice Address - Street 1:1025 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4049
Practice Address - Country:US
Practice Address - Phone:985-876-5790
Practice Address - Fax:985-876-9371
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1954357Medicaid
LA1954357Medicaid
LAU02265Medicare UPIN