Provider Demographics
NPI:1962683151
Name:JOANNE BUSHMAN DC PA
Entity Type:Organization
Organization Name:JOANNE BUSHMAN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-543-1230
Mailing Address - Street 1:30349 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2406
Mailing Address - Country:US
Mailing Address - Phone:410-543-1230
Mailing Address - Fax:410-543-1263
Practice Address - Street 1:305 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4218
Practice Address - Country:US
Practice Address - Phone:410-543-1230
Practice Address - Fax:410-543-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM097OtherBLUE CROSS & BLUE SHIELD
MDM097OtherBLUE CROSS & BLUE SHIELD