Provider Demographics
NPI:1730291345
Name:RUSH, BRIAN CORY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CORY
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 1:10830 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5205
Mailing Address - Country:US
Mailing Address - Phone:954-432-5006
Mailing Address - Fax:954-435-3777
Practice Address - Street 1:10830 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5205
Practice Address - Country:US
Practice Address - Phone:954-432-5006
Practice Address - Fax:954-435-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8137111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00258531OtherMED. RAILROAD
FLU90288Medicare UPIN
FLP00258531OtherMED. RAILROAD