Provider Demographics
NPI:1922649060
Name:BUSH, CONRAD LATEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:LATEN
Last Name:BUSH
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 1:1001 HUDSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2304
Mailing Address - Country:US
Mailing Address - Phone:319-277-5616
Mailing Address - Fax:319-277-0355
Practice Address - Street 1:1001 HUDSON RD STE A
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2304
Practice Address - Country:US
Practice Address - Phone:319-277-5616
Practice Address - Fax:319-277-0355
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor