Provider Demographics
NPI:1073889879
Name:THE BUSHMAN CLINIC OF CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:THE BUSHMAN CLINIC OF CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-588-5321
Mailing Address - Street 1:6718 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4869
Mailing Address - Country:US
Mailing Address - Phone:865-588-5321
Mailing Address - Fax:865-588-7114
Practice Address - Street 1:6718 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4869
Practice Address - Country:US
Practice Address - Phone:865-588-5321
Practice Address - Fax:865-588-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672167Medicare PIN