Provider Demographics
NPI:1750343869
Name:BUSHMAN, BRADLEY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALAN
Last Name:BUSHMAN
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 1:15189 SOUTH HELMER RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9601
Mailing Address - Country:US
Mailing Address - Phone:269-753-0302
Mailing Address - Fax:269-753-0313
Practice Address - Street 1:15189 HELMER RD S
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9601
Practice Address - Country:US
Practice Address - Phone:269-753-0302
Practice Address - Fax:269-753-0313
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB008893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28610Medicare ID - Type Unspecified
MIV08507Medicare UPIN