Provider Demographics
NPI:1831202472
Name:OSBORNE-KIRKEMO, PATRICIA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:OSBORNE-KIRKEMO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:KIRKEMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:311 E MAIN ST STE 417
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-4867
Mailing Address - Country:US
Mailing Address - Phone:309-368-5141
Mailing Address - Fax:
Practice Address - Street 1:311 E MAIN ST STE 417
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4867
Practice Address - Country:US
Practice Address - Phone:309-368-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1921738OtherBC/BS
IL2707OtherMEDICARE PTAN
IL038-007910OtherPROF STATE LICENSE
ILU20986Medicare UPIN
IL00289330Medicare ID - Type Unspecified