Provider Demographics
NPI:1902814247
Name:BOURGEOIS, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BOURGEOIS
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 1:134 GARNER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3132
Mailing Address - Country:US
Mailing Address - Phone:864-583-8113
Mailing Address - Fax:864-583-0825
Practice Address - Street 1:134 GARNER RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3132
Practice Address - Country:US
Practice Address - Phone:864-583-8113
Practice Address - Fax:864-583-0825
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor