Provider Demographics
NPI:1578668539
Name:TUGGLE, JOHN DANTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANTON
Last Name:TUGGLE
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 1:930 S BELL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3972
Mailing Address - Country:US
Mailing Address - Phone:512-257-2225
Mailing Address - Fax:512-257-3688
Practice Address - Street 1:930 S BELL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3972
Practice Address - Country:US
Practice Address - Phone:512-257-2225
Practice Address - Fax:512-257-3688
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609488Medicare ID - Type UnspecifiedMEDICARE #
U83816Medicare UPIN