Provider Demographics
NPI:1255365706
Name:PUGH, MICHAEL N (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:PUGH
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 1:148 W TIVERTON WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4468
Mailing Address - Country:US
Mailing Address - Phone:859-272-5460
Mailing Address - Fax:859-272-5463
Practice Address - Street 1:148 W TIVERTON WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4468
Practice Address - Country:US
Practice Address - Phone:859-272-5460
Practice Address - Fax:859-272-5463
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU82684Medicare UPIN
KYU82684Medicare UPIN
KY6103501Medicare ID - Type Unspecified