Healthcare Provider Details

I. General information

NPI: 1144815333
Provider Name (Legal Business Name): SETH BUGG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 05/08/2022
Certification Date: 05/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 INDIANA CT STE 105
REDLANDS CA
92374-4540
US

IV. Provider business mailing address

34595 AVENUE H
YUCAIPA CA
92399-5325
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-4515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number35026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: