Provider Demographics
NPI:1023008448
Name:BOURGET, JEAN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEAN PAUL
Middle Name:
Last Name:BOURGET
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 1:1280 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4805
Mailing Address - Country:US
Mailing Address - Phone:408-243-0696
Mailing Address - Fax:
Practice Address - Street 1:1280 BENTON ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4805
Practice Address - Country:US
Practice Address - Phone:408-243-0696
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0292710Medicare ID - Type Unspecified