Healthcare Provider Details

I. General information

NPI: 1578773164
Provider Name (Legal Business Name): DR. DAVID J BOUGIE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 GLADES RD STE C
BOCA RATON FL
33434-3939
US

IV. Provider business mailing address

395 NE 28TH TER
BOCA RATON FL
33431-6834
US

V. Phone/Fax

Practice location:
  • Phone: 561-826-3664
  • Fax: 561-826-3663
Mailing address:
  • Phone: 561-376-3699
  • Fax: 954-764-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0007985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: