Provider Demographics
NPI:1134398449
Name:BUSSARD CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BUSSARD CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-854-7700
Mailing Address - Street 1:24837 104TH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6800
Mailing Address - Country:US
Mailing Address - Phone:253-854-7700
Mailing Address - Fax:
Practice Address - Street 1:24837 104TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6800
Practice Address - Country:US
Practice Address - Phone:253-854-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003693261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB09155Medicare UPIN