Healthcare Provider Details

I. General information

NPI: 1326032756
Provider Name (Legal Business Name): JONATHAN E BUGH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 MISSION OAKS BLVD
CAMARILLO CA
93012-5403
US

IV. Provider business mailing address

5239 MISSION OAKS BLVD
CAMARILLO CA
93012-5403
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-7500
  • Fax: 805-484-9495
Mailing address:
  • Phone: 805-484-7500
  • Fax: 805-484-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: