MEDICARE: DR. JEFFREY DONALD BOURGUIGNON D.C.

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	CH10968	FL

General Provider Information

NPI Number	:	1154754117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DONALD BOURGUIGNON D.C.

Provider Business Mailing Address
First Line	:	3712 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8725
Country	:	US
Telephone Number	:	813-600-5391
Fax Number	:	813-600-5291

Provider Business Practice Location Address
First Line	:	3712 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8725
Country	:	US
Telephone Number	:	813-600-5391
Fax Number	:	813-600-5291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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