Provider Demographics
NPI:1801580170
Name:BC FUGATE PLLC
Entity type:Organization
Organization Name:BC FUGATE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-278-5800
Mailing Address - Street 1:2417 NICHOLASVILLE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3178
Mailing Address - Country:US
Mailing Address - Phone:859-278-5800
Mailing Address - Fax:859-278-8102
Practice Address - Street 1:2417 NICHOLASVILLE RD STE 114
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3178
Practice Address - Country:US
Practice Address - Phone:859-278-5800
Practice Address - Fax:859-278-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty