Provider Demographics
NPI:1407461882
Name:FUGATE, BRYCE CHANNING (DC)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:CHANNING
Last Name:FUGATE
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 1:2417 NICHOLASVILLE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3178
Mailing Address - Country:US
Mailing Address - Phone:859-278-5800
Mailing Address - Fax:859-568-5510
Practice Address - Street 1:2417 NICHOLASVILLE RD STE 114
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3178
Practice Address - Country:US
Practice Address - Phone:859-278-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor