Provider Demographics
NPI:1326032756
Name:BUGH, JONATHAN E (DC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:E
Last Name:BUGH
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 1:5239 MISSION OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5403
Mailing Address - Country:US
Mailing Address - Phone:805-484-7500
Mailing Address - Fax:805-484-9495
Practice Address - Street 1:5239 MISSION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5403
Practice Address - Country:US
Practice Address - Phone:805-484-7500
Practice Address - Fax:805-484-9495
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00206607OtherRAILROAD MEDICARE
CADC15501OtherLICENSE NUMBER
CAP00206607OtherRAILROAD MEDICARE