=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598863979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD JOSEPH BUSS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 ANSBOROUGH AVE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-3430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-232-9436
-----------------------------------------------------
Fax | 319-232-2342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1445 ANSBOROUGH AVE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-3430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-232-9436
-----------------------------------------------------
Fax | 319-232-2342
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 007104
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-30051
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------