MEDICARE: EAGLE FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5087	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386053452	OTHER	WI	CHIROPRACTOR
2	1386053452	OTHER	WI	OTHER INSURANCE

General Provider Information

NPI Number	:	1134645682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	701 N RAILROAD ST
Second Line	:
City	:	EAGLE RIVER
State	:	WI
Zip	:	54521-8833
Country	:	US
Telephone Number	:	715-479-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N RAILROAD ST
Second Line	:
City	:	EAGLE RIVER
State	:	WI
Zip	:	54521-8833
Country	:	US
Telephone Number	:	715-479-4214
Fax Number	:	715-477-2770

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MARK JAMES BUGNI
Credential	:	DC
Telephone Number	:	715-479-4214

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	07/21/2022

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Directions to “EAGLE FAMILY CHIROPRACTIC ” Practice Location

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