Provider Demographics
NPI:1811071327
Name:OSBORN, KENNETH JEFFERY (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JEFFERY
Last Name:OSBORN
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 1:3663 SNOUFFER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2780
Mailing Address - Country:US
Mailing Address - Phone:614-789-2200
Mailing Address - Fax:614-789-0732
Practice Address - Street 1:3663 SNOUFFER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2780
Practice Address - Country:US
Practice Address - Phone:614-789-2200
Practice Address - Fax:614-789-0732
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1034111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311-229921026OtherCARESOURCE PROVIDER #
OH124059000OtherOFWC PROVIDER #
OH13240-0001OtherCARE SOURCE PIN #
OH000000119164OtherANTHEM PROVIDER #
OH311229921-00OtherOBWC PROVIDER #
OH311229921-002OtherCENTRAL BENEFITS #
OH350055581OtherRAILROAD MEDICARE #
OH2240Medicaid
OHT48016Medicare UPIN
OH350055581OtherRAILROAD MEDICARE #