Provider Demographics
NPI:1093846198
Name:AMERIGO, AUGUSTINE J I (DC)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:J
Last Name:AMERIGO
Suffix:I
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 1:164 W HOSPITALITY LN
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3316
Mailing Address - Country:US
Mailing Address - Phone:909-884-1277
Mailing Address - Fax:909-532-8611
Practice Address - Street 1:164 W HOSPITALITY LN
Practice Address - Street 2:STE 110
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3316
Practice Address - Country:US
Practice Address - Phone:909-884-1277
Practice Address - Fax:909-532-8611
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17593ZMedicare ID - Type Unspecified