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General NPI Number Information
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NPI Number | 1114089737
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Entity Type | Organization
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Legal Business Name | BOURGEOIS FAMILY CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1603 ROUTE 9
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City | CLIFTON PARK
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State | NY
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Zip | 12065-4380
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Country | US
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Telephone | 518-348-0287
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Fax | 518-348-0284
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Provider Business Mailing Address
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Address Line | 1603 ROUTE 9
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City | CLIFTON PARK
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State | NY
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Zip | 12065-4380
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Country | US
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Telephone | 518-348-0287
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Fax | 518-348-0284
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | DR. GARY PAUL BOURGEOIS
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Credential | D.C.
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Telephone | 518-348-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | X006369
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License Number State | NY
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