Provider Demographics
NPI:1396811642
Name:VANBUSKIRK, ROD S (DC)
Entity type:Individual
Prefix:DR
First Name:ROD
Middle Name:S
Last Name:VANBUSKIRK
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 1:710 GRAYSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2687
Mailing Address - Country:US
Mailing Address - Phone:925-932-3289
Mailing Address - Fax:925-932-1786
Practice Address - Street 1:710 GRAYSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2687
Practice Address - Country:US
Practice Address - Phone:925-932-3289
Practice Address - Fax:925-932-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0189870Medicare ID - Type Unspecified