Provider Demographics
NPI:1114089737
Name:BOURGEOIS FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BOURGEOIS FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-348-0287
Mailing Address - Street 1:1603 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4380
Mailing Address - Country:US
Mailing Address - Phone:518-348-0287
Mailing Address - Fax:518-348-0284
Practice Address - Street 1:1603 ROUTE 9
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4380
Practice Address - Country:US
Practice Address - Phone:518-348-0287
Practice Address - Fax:518-348-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006369261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UO9736Medicare UPIN
BB5649Medicare ID - Type Unspecified