Provider Demographics
NPI:1780343772
Name:BUSH, MADISON CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:CHRISTINE
Last Name:BUSH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2247
Mailing Address - Country:US
Mailing Address - Phone:315-767-4938
Mailing Address - Fax:
Practice Address - Street 1:1225 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7614
Practice Address - Country:US
Practice Address - Phone:585-473-7746
Practice Address - Fax:585-473-7745
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor