Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC-1129 | TN |
NPI | 1245392067 |
---|---|
Provider Name | Dr. Robert James Bussenger |
First Address | Cordova, TN 38016-0510 |
Second Address | Cordova, TN 38016-0510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |