Provider Demographics
NPI:1689027641
Name:RUSH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RUSH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-583-3065
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-0064
Mailing Address - Country:US
Mailing Address - Phone:417-583-3065
Mailing Address - Fax:417-583-3064
Practice Address - Street 1:7450 STATE HIGHWAY 14 W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MO
Practice Address - Zip Code:65610-9489
Practice Address - Country:US
Practice Address - Phone:417-583-3065
Practice Address - Fax:417-583-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015014359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty