Provider Demographics
NPI:1174600050
Name:OSBORNE, THAYER (DC)
Entity type:Individual
Prefix:DR
First Name:THAYER
Middle Name:
Last Name:OSBORNE
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 1:14 SCHOOL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1210
Mailing Address - Country:US
Mailing Address - Phone:802-453-5588
Mailing Address - Fax:802-453-7878
Practice Address - Street 1:14 SCHOOL ST
Practice Address - Street 2:BOX 6
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1210
Practice Address - Country:US
Practice Address - Phone:802-453-5588
Practice Address - Fax:802-453-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT60001148111N00000X
VT006-0001184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3637Medicare ID - Type UnspecifiedCHIROPRACTOR