Provider Demographics
NPI:1205100641
Name:BRIAN C. RUSH D. C. P. A.
Entity type:Organization
Organization Name:BRIAN C. RUSH D. C. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:954-432-5006
Mailing Address - Street 1:10830 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5205
Mailing Address - Country:US
Mailing Address - Phone:954-432-5006
Mailing Address - Fax:954-435-3777
Practice Address - Street 1:10830 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5205
Practice Address - Country:US
Practice Address - Phone:954-432-5006
Practice Address - Fax:954-435-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU90288Medicare UPIN
FL54006Medicare PIN