Provider Demographics
NPI:1275676348
Name:RUSH, ROBERT ZACHARY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ZACHARY
Last Name:RUSH
Suffix:
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 1:13044 BUSTLETON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1602
Mailing Address - Country:US
Mailing Address - Phone:215-677-2225
Mailing Address - Fax:
Practice Address - Street 1:13044 BUSTLETON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1602
Practice Address - Country:US
Practice Address - Phone:215-677-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5386L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0654571000OtherPERSONAL CHOICE PROVIDER
PA745376OtherBLUE SHIELD PROVIDER
PA0654571000OtherPERSONAL CHOICE PROVIDER