Provider Demographics
NPI:1417904970
Name:BUSH, AMBER NOELLE (DC)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:NOELLE
Last Name:BUSH
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 1:197 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3505
Mailing Address - Country:US
Mailing Address - Phone:559-783-2225
Mailing Address - Fax:559-788-2225
Practice Address - Street 1:197 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3505
Practice Address - Country:US
Practice Address - Phone:559-783-2225
Practice Address - Fax:559-788-2225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor