Provider Demographics
NPI:1134645682
Name:EAGLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:EAGLE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUGNI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-479-4214
Mailing Address - Street 1:701 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-8833
Mailing Address - Country:US
Mailing Address - Phone:715-479-4214
Mailing Address - Fax:
Practice Address - Street 1:701 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8833
Practice Address - Country:US
Practice Address - Phone:715-479-4214
Practice Address - Fax:715-477-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386053452OtherCHIROPRACTOR
WI1386053452OtherOTHER INSURANCE