Provider Demographics
NPI:1023021102
Name:BUSCH, JEREMY J (MED, ATC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:J
Last Name:BUSCH
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CUNNINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5931
Mailing Address - Country:US
Mailing Address - Phone:970-491-0272
Mailing Address - Fax:970-491-6167
Practice Address - Street 1:141 MOBY ARENA
Practice Address - Street 2:0120 ATHLETIC TRAINING
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0120
Practice Address - Country:US
Practice Address - Phone:970-491-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist