Provider Demographics
NPI:1578773164
Name:BOUGIE, DAVID J JR
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BOUGIE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 NE 28TH TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6834
Mailing Address - Country:US
Mailing Address - Phone:561-376-3699
Mailing Address - Fax:954-764-4940
Practice Address - Street 1:1234 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1925
Practice Address - Country:US
Practice Address - Phone:954-764-4940
Practice Address - Fax:954-764-4942
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0007985Medicare UPIN