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General NPI Number Information
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NPI Number | 1134645682
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Entity Type | Organization
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Legal Business Name | EAGLE FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 701 N RAILROAD ST
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City | EAGLE RIVER
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State | WI
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Zip | 54521-8833
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Country | US
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Telephone | 715-479-4214
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Fax | 715-477-2770
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Provider Business Mailing Address
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Address Line | 701 N RAILROAD ST
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City | EAGLE RIVER
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State | WI
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Zip | 54521-8833
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Country | US
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Telephone | 715-479-4214
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MARK JAMES BUGNI
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Credential | DC
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Telephone | 715-479-4214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5087
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License Number State | WI
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