Provider Demographics
NPI:1184754491
Name:BUSHNELL, SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:BUSHNELL
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 1:11245 WILD BERRY LAN
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-3408
Mailing Address - Country:US
Mailing Address - Phone:708-478-6879
Mailing Address - Fax:
Practice Address - Street 1:1018 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3408
Practice Address - Country:US
Practice Address - Phone:773-772-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38007892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor