MEDICARE: MR. JONATHAN E BUGH DC

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	DC15501	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00206607	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC15501	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1326032756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN E BUGH DC

Provider Business Mailing Address
First Line	:	5239 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-484-7500
Fax Number	:	805-484-9495

Provider Business Practice Location Address
First Line	:	5239 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-484-7500
Fax Number	:	805-484-9495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	11/01/2011

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