Provider Demographics
NPI:1932246394
Name:FUGLEBERG, JOEL THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:THOMAS
Last Name:FUGLEBERG
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 1:821 SIBLEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1709
Mailing Address - Country:US
Mailing Address - Phone:612-849-6586
Mailing Address - Fax:651-406-4453
Practice Address - Street 1:821 SIBLEY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-1709
Practice Address - Country:US
Practice Address - Phone:612-849-6586
Practice Address - Fax:651-406-4453
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor