Provider Demographics
NPI:1588608798
Name:RUSH, ROBERT A (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:RUSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1218
Mailing Address - Country:US
Mailing Address - Phone:215-536-5262
Mailing Address - Fax:215-536-2366
Practice Address - Street 1:600 W BROAD ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1218
Practice Address - Country:US
Practice Address - Phone:215-536-5262
Practice Address - Fax:215-536-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001318L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72668Medicare UPIN
PA112532Medicare ID - Type Unspecified