Provider Demographics
NPI:1942344254
Name:BUSHMAN, PHILIP I (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:I
Last Name:BUSHMAN
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 1:7424 TRICIA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1796
Mailing Address - Country:US
Mailing Address - Phone:505-610-5464
Mailing Address - Fax:505-437-0005
Practice Address - Street 1:7424 TRICIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1796
Practice Address - Country:US
Practice Address - Phone:505-610-5464
Practice Address - Fax:505-437-0005
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035560111N00000X
NM2090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor