Provider Demographics
NPI:1497776819
Name:BUSHMAN, SUSAN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:BUSHMAN
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 1:14377 WOODLAKE DR
Mailing Address - Street 2:STE. 315
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-878-8999
Mailing Address - Fax:314-878-8915
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:STE. 315
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-878-8999
Practice Address - Fax:314-878-8915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003003215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2679OtherMEDICARE GROUP PTAN
MOPTAN MA2679001Medicare PIN