Basic Information
| Provider Information | |||||||||
| NPI: | 1396814661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUSHINSKY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2976 N SCATTERFIELD RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460121585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656438781 | ||||||||
| FaxNumber: | 7656220126 | ||||||||
| Practice Location | |||||||||
| Address1: | 2976 N SCATTERFIELD RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460121585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656438781 | ||||||||
| FaxNumber: | 7656220126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 08001691A | IN | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 200473220A | 05 | IN | MEDICAID | 000000323449 | 01 | IN | ANTHEM BCBS PIN NUMBER | OTHER |