Provider Demographics
NPI:1699842328
Name:BUESCHER, CLARK MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:MICHAEL
Last Name:BUESCHER
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 1:1524 W. GLEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-692-6800
Mailing Address - Fax:309-692-4478
Practice Address - Street 1:1524 W. GLEN AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-692-3800
Practice Address - Fax:309-692-4478
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-3404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL072-82005OtherBCBS
ILT35804Medicare UPIN
IL072-82005OtherBCBS