Provider Demographics
NPI:1740206564
Name:BUSH, DAVID CHARLES (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:BUSH
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 1:23161 VENTURA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1125
Mailing Address - Country:US
Mailing Address - Phone:818-340-2033
Mailing Address - Fax:818-223-9288
Practice Address - Street 1:23161 VENTURA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1125
Practice Address - Country:US
Practice Address - Phone:818-340-2033
Practice Address - Fax:818-223-9288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13468Medicare UPIN
CADC19070Medicare ID - Type Unspecified