Provider Demographics
NPI:1295955516
Name:FUSION CHIROPRACTIC SPA
Entity type:Organization
Organization Name:FUSION CHIROPRACTIC SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVIN
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:FUGERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-362-6461
Mailing Address - Street 1:9191 KYSER WAY
Mailing Address - Street 2:SUITE 605
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-362-6461
Mailing Address - Fax:469-362-6475
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:469-362-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty