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General NPI Number Information
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NPI Number | 1538359187
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Entity Type | Organization
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Legal Business Name | BUSH CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 2402 LAKE DR NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-5008
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Country | US
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Telephone | 863-965-2999
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Fax | 863-965-2990
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Provider Business Mailing Address
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Address Line | 2402 LAKE DR NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-5008
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Country | US
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Telephone | 863-965-2999
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Fax | 863-965-2990
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY W. BUSH
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Credential | D.C.
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Telephone | 863-965-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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