Provider Demographics
NPI:1912246216
Name:JACK R. DUGO, JR., D.C., LLC
Entity Type:Organization
Organization Name:JACK R. DUGO, JR., D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:732-615-9420
Mailing Address - Street 1:20 CHERRY TREE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2251
Mailing Address - Country:US
Mailing Address - Phone:732-615-9420
Mailing Address - Fax:
Practice Address - Street 1:20 CHERRY TREE FARM RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2251
Practice Address - Country:US
Practice Address - Phone:732-615-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty