MEDICARE: RUSH CHIROPRACTIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1164933438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	2755 N WICKHAM RD STE 104
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2226
Country	:	US
Telephone Number	:	321-254-3888
Fax Number	:	321-254-0097

Provider Business Practice Location Address
First Line	:	2755 N WICKHAM RD STE 104
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2226
Country	:	US
Telephone Number	:	321-254-3888
Fax Number	:	321-254-0097

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EVAN RUSH
Credential	:	DC
Telephone Number	:	321-254-3888

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	10/13/2017

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Directions to “RUSH CHIROPRACTIC INC. ” Practice Location

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