MEDICARE: JONATHAN E. BUGH D.C. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC15501	CA

General Provider Information

NPI Number	:	1134495120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN E. BUGH D.C. INC.

Provider Business Mailing Address
First Line	:	5239 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-484-7500
Fax Number	:	805-484-9495

Provider Business Practice Location Address
First Line	:	5239 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-484-7500
Fax Number	:	805-484-9495

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSIE BUGH
Credential	:
Telephone Number	:	805-484-7500

Provider Enumeration Date	:	03/24/2012
Last Update Date	:	04/23/2012

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