Provider Demographics
NPI:1790024537
Name:BUSHWICK, YIZHAK (DC)
Entity Type:Individual
Prefix:DR
First Name:YIZHAK
Middle Name:
Last Name:BUSHWICK
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 1:1120 N CHARLES ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5592
Mailing Address - Country:US
Mailing Address - Phone:410-522-7746
Mailing Address - Fax:410-510-1844
Practice Address - Street 1:1120 N CHARLES ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5592
Practice Address - Country:US
Practice Address - Phone:410-522-7746
Practice Address - Fax:410-510-1844
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010700111N00000X
MDS03745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor