Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1369 | WI |
NPI | 1235299751 |
---|---|
Provider Name | Dr. Roy M. Ostenson |
First Address | Appleton, WI 54914-3110 |
Second Address | Appleton, WI 54914-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |