Healthcare Provider Details

I. General information

NPI: 1699885723
Provider Name (Legal Business Name): JOHN DOUGLAS BUSCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 4TH ST STE 100
MISHAWAKA IN
46544-1948
US

IV. Provider business mailing address

53040 GLENMOOR ST
ELKHART IN
46514-8923
US

V. Phone/Fax

Practice location:
  • Phone: 888-580-1060
  • Fax:
Mailing address:
  • Phone: 574-651-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR5101
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: