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General NPI Number Information
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NPI Number | 1578773164
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Entity Type | Individual
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Provider Name | DR. DAVID J BOUGIE JR.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1234 NE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1925
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Country | US
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Telephone | 954-764-4940
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Fax | 954-764-4942
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Provider Business Mailing Address
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Address Line | 395 NE 28TH TER
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City | BOCA RATON
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State | FL
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Zip | 33431-6834
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Country | US
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Telephone | 561-376-3699
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Fax | 954-764-4940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH0007985
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License Number State | FL
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