Provider Demographics
NPI:1598219735
Name:BUSHMAN FAMILY CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:BUSHMAN FAMILY CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-753-0302
Mailing Address - Street 1:15189 HELMER RD S
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9601
Mailing Address - Country:US
Mailing Address - Phone:269-753-0302
Mailing Address - Fax:269-753-0313
Practice Address - Street 1:15189 HELMER RD S
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9601
Practice Address - Country:US
Practice Address - Phone:269-753-0302
Practice Address - Fax:269-753-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28610OtherMEDICARE IDENTIFICATION NUMBER
MI4891544Medicaid