MEDICARE: DR. RICHARD E BUSCH III D.C.

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	08001648	IN

General Provider Information

NPI Number	:	1477612141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E BUSCH III D.C.

Provider Business Mailing Address
First Line	:	5005 RIVIERA CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5805
Country	:	US
Telephone Number	:	260-471-4090
Fax Number	:	260-471-9919

Provider Business Practice Location Address
First Line	:	5005 RIVIERA CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5805
Country	:	US
Telephone Number	:	260-471-4090
Fax Number	:	260-471-9919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	01/25/2008

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