Provider Demographics
NPI:1154754117
Name:BOURGUIGNON, JEFFREY DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DONALD
Last Name:BOURGUIGNON
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 1:3712 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8725
Mailing Address - Country:US
Mailing Address - Phone:813-600-5391
Mailing Address - Fax:813-600-5291
Practice Address - Street 1:3712 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8725
Practice Address - Country:US
Practice Address - Phone:813-600-5391
Practice Address - Fax:813-600-5291
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor