Provider Demographics
NPI:1538825369
Name:BOURGOUIN CHIROPRACTIC INC.
Entity type:Organization
Organization Name:BOURGOUIN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOURGOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-846-1831
Mailing Address - Street 1:2414 TORREJON PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8033
Mailing Address - Country:US
Mailing Address - Phone:760-846-1831
Mailing Address - Fax:
Practice Address - Street 1:320 S CEDROS AVE STE 300
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1996
Practice Address - Country:US
Practice Address - Phone:858-481-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty