Healthcare Provider Details

I. General information

NPI: 1063375319
Provider Name (Legal Business Name): TODD BUSHMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 W KAGY BLVD
BOZEMAN MT
59715-6052
US

IV. Provider business mailing address

81 W KAGY BLVD
BOZEMAN MT
59715-6052
US

V. Phone/Fax

Practice location:
  • Phone: 720-207-3316
  • Fax:
Mailing address:
  • Phone: 720-207-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TODD BUSHMAN
Title or Position: OWNER
Credential:
Phone: 720-207-3316