Provider Demographics
NPI:1194915363
Name:RUSH, PERRY O'NEAL (DC)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:O'NEAL
Last Name:RUSH
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 1:1175 MIDNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-9085
Mailing Address - Country:US
Mailing Address - Phone:864-578-3252
Mailing Address - Fax:
Practice Address - Street 1:1175 MIDNIGHT RD
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-9085
Practice Address - Country:US
Practice Address - Phone:864-578-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor