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General NPI Number Information
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NPI Number | 1699885723
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Entity Type | Individual
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Provider Name | JOHN DOUGLAS BUSCH D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 420 W 4TH ST STE 100
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City | MISHAWAKA
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State | IN
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Zip | 46544-1948
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Country | US
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Telephone | 888-580-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 53040 GLENMOOR ST
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City | ELKHART
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State | IN
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Zip | 46514-8923
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Country | US
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Telephone | 574-651-7305
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR5101
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License Number State | CO
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