Provider Demographics
NPI:1588742944
Name:OSBORN, MARK JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6001 SOUTH 58TH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3644
Mailing Address - Country:US
Mailing Address - Phone:402-423-8226
Mailing Address - Fax:402-423-8712
Practice Address - Street 1:6001 SOUTH 58TH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3644
Practice Address - Country:US
Practice Address - Phone:402-423-8226
Practice Address - Fax:402-423-8712
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
99552OtherBCBS OF NEBRASKA
NE01058181500Medicaid
4400035OtherUHC
10123OtherMIDLANDS CHOICE
10123OtherMIDLANDS CHOICE
T71400Medicare UPIN