Healthcare Provider Details

I. General information

NPI: 1730291345
Provider Name (Legal Business Name): BRIAN CORY RUSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 PINES BLVD
PEMBROKE PINES FL
33026-5205
US

IV. Provider business mailing address

10830 PINES BLVD
PEMBROKE PINES FL
33026-5205
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-5006
  • Fax: 954-435-3777
Mailing address:
  • Phone: 954-432-5006
  • Fax: 954-435-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH8137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: