Provider Demographics
NPI:1942217849
Name:OOSTERHART, KAREEN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:KAREEN
Middle Name:LEE
Last Name:OOSTERHART
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:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-1455
Mailing Address - Country:US
Mailing Address - Phone:231-258-4023
Mailing Address - Fax:231-258-3291
Practice Address - Street 1:798 W MILE RD NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8431
Practice Address - Country:US
Practice Address - Phone:231-258-4023
Practice Address - Fax:231-258-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3470477Medicaid
MI950D050000OtherBLUE CROSS BLUESHIELD
MIOM61410Medicare ID - Type Unspecified
MI3470477Medicaid