Provider Demographics
NPI:1003987322
Name:PUGSLEY, PAUL FEDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FEDERICK
Last Name:PUGSLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 CAMPO RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1609
Mailing Address - Country:US
Mailing Address - Phone:619-465-9300
Mailing Address - Fax:619-465-9373
Practice Address - Street 1:9901 CAMPO RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1609
Practice Address - Country:US
Practice Address - Phone:619-465-9300
Practice Address - Fax:619-465-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18347Medicare UPIN