Provider Demographics
NPI:1548455298
Name:BUSHONG, BRAD ALEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALEN
Last Name:BUSHONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SAMARITANS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2452
Mailing Address - Country:US
Mailing Address - Phone:336-526-3003
Mailing Address - Fax:336-526-3004
Practice Address - Street 1:189 SAMARITANS RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2452
Practice Address - Country:US
Practice Address - Phone:336-526-3003
Practice Address - Fax:336-526-3004
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015837111N00000X
NC4154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor