Provider Demographics
NPI:1467586560
Name:FUGERE, TREVIN M (DC)
Entity Type:Individual
Prefix:
First Name:TREVIN
Middle Name:M
Last Name:FUGERE
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 1:4398 CHILDRESS TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8486
Mailing Address - Country:US
Mailing Address - Phone:469-362-6461
Mailing Address - Fax:972-596-9072
Practice Address - Street 1:9191 KYSER WAY
Practice Address - Street 2:SUITE 605
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:469-362-6461
Practice Address - Fax:972-596-9072
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B1471Medicare ID - Type Unspecified