Healthcare Provider Details

I. General information

NPI: 1194576959
Provider Name (Legal Business Name): BUSH CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CENTENNIAL CENTRE BLVD STE 150
HOBART WI
54155-8918
US

IV. Provider business mailing address

560 CENTENNIAL CENTRE BLVD STE 150
HOBART WI
54155-8918
US

V. Phone/Fax

Practice location:
  • Phone: 920-865-7225
  • Fax:
Mailing address:
  • Phone: 920-865-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC BUSH
Title or Position: SOLE MEMBER
Credential: DC
Phone: 920-865-7225