Provider Demographics
NPI:1558423699
Name:MBUGUA, GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MBUGUA
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 1:16 MILK ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5144
Mailing Address - Country:US
Mailing Address - Phone:978-688-4215
Mailing Address - Fax:
Practice Address - Street 1:597 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3306
Practice Address - Country:US
Practice Address - Phone:978-275-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37079OtherBLUECROSS BLUE SHIELD