Provider Demographics
NPI:1477634939
Name:BUSSO, KAREN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNN
Last Name:BUSSO
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 483
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-3140
Mailing Address - Fax:360-692-1441
Practice Address - Street 1:3595 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-698-3140
Practice Address - Fax:360-692-1441
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203760203760OtherPREMERA BLUE CROSS
WA91118703306OtherKPS
WA150899OtherLFI
U89283Medicare UPIN
WAAB26494Medicare ID - Type Unspecified