Provider Demographics
NPI:1073710265
Name:NUGENT, JEANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:BARBARA
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 3763
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-3763
Mailing Address - Country:US
Mailing Address - Phone:928-848-8088
Mailing Address - Fax:928-445-0387
Practice Address - Street 1:1027 FAIR STREET STE D
Practice Address - Street 2:FAMILY CHIROPRACTIC
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1897
Practice Address - Country:US
Practice Address - Phone:928-445-2652
Practice Address - Fax:928-445-0387
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU83534Medicare UPIN