=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073889879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BUSHMAN CLINIC OF CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2012
-----------------------------------------------------
Last Update Date | 03/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6718 KINGSTON PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-4869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-5321
-----------------------------------------------------
Fax | 865-588-7114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6718 KINGSTON PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-4869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-5321
-----------------------------------------------------
Fax | 865-588-7114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DENNIS MARK BUSHMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 865-588-5321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 264
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------