Provider Demographics
NPI:1124017579
Name:BUSSIE, DELORES LAVERN (DC)
Entity Type:Individual
Prefix:DR
First Name:DELORES
Middle Name:LAVERN
Last Name:BUSSIE
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 1:784 U.S. HIGHWAY 1
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4411
Mailing Address - Country:US
Mailing Address - Phone:561-799-0223
Mailing Address - Fax:561-799-0263
Practice Address - Street 1:784 US HIGHWAY 1
Practice Address - Street 2:SUITE 12
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4415
Practice Address - Country:US
Practice Address - Phone:561-799-0223
Practice Address - Fax:561-799-0263
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBB520ZOtherMEDICARE PTAN