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General NPI Number Information
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NPI Number | 1619038064
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Entity Type | Individual
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Provider Name | EDWIN BUSH JR. CHIROPRACTOR
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 2900 DEKALB AVE
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone | 815-739-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 DEKALB AVE.
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone | 815-758-2911
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Fax | 815-758-1877
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038.005637
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038005637
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License Number State | IL
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