1962683151 NPI number — JOANNE BUSHMAN DC PA

Table of content: (NPI 1962683151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962683151 NPI number — JOANNE BUSHMAN DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOANNE BUSHMAN DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962683151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30349 HOLLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELMAR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21875-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-1230
Provider Business Mailing Address Fax Number:
410-543-1263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 N DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-1230
Provider Business Practice Location Address Fax Number:
410-543-1263
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUSHMAN
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
410-543-1230

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M097 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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