Provider Demographics
NPI:1619159522
Name:FUGERE ENTERPRISES INC.
Entity Type:Organization
Organization Name:FUGERE ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUGERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-987-0299
Mailing Address - Street 1:2180 NW 156TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7982
Mailing Address - Country:US
Mailing Address - Phone:515-987-0299
Mailing Address - Fax:515-987-5865
Practice Address - Street 1:2180 NW 156TH ST
Practice Address - Street 2:STE 102
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7982
Practice Address - Country:US
Practice Address - Phone:515-987-0299
Practice Address - Fax:515-987-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2137992Medicaid
IA05949Medicare UPIN
IAI7328Medicare PIN