Provider Demographics
NPI:1730531880
Name:OSTERHAUS, LARA (DC)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:OSTERHAUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 W HORSETOOTH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5981
Mailing Address - Country:US
Mailing Address - Phone:970-223-5501
Mailing Address - Fax:
Practice Address - Street 1:1027 W HORSETOOTH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5981
Practice Address - Country:US
Practice Address - Phone:970-223-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor