MEDICARE: DR. DAVID J BOUGIE JR.

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	CH0007985	FL

General Provider Information

NPI Number	:	1578773164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J BOUGIE JR.

Provider Business Mailing Address
First Line	:	395 NE 28TH TER
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6834
Country	:	US
Telephone Number	:	561-376-3699
Fax Number	:	954-764-4940

Provider Business Practice Location Address
First Line	:	1234 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1925
Country	:	US
Telephone Number	:	954-764-4940
Fax Number	:	954-764-4942

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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