Provider Demographics
NPI:1790560647
Name:PUGSLEY, ROBERT SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHANE
Last Name:PUGSLEY
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 1:4046 SHADY MILL CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-5147
Mailing Address - Country:US
Mailing Address - Phone:417-693-2856
Mailing Address - Fax:
Practice Address - Street 1:4046 SHADY MILL CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-5147
Practice Address - Country:US
Practice Address - Phone:417-693-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor