Provider Demographics
NPI:1972613461
Name:BUSH, NICOLAE NICK JR (DC)
Entity Type:Individual
Prefix:MR
First Name:NICOLAE
Middle Name:NICK
Last Name:BUSH
Suffix:JR
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 1:5080 FOOTHILLS BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747
Mailing Address - Country:US
Mailing Address - Phone:916-780-5260
Mailing Address - Fax:916-780-5220
Practice Address - Street 1:5080 FOOTHILLS BLVD
Practice Address - Street 2:SUITE 1B
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:916-780-5260
Practice Address - Fax:916-780-5220
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88392Medicare UPIN
CADC0266860Medicare ID - Type Unspecified