Provider Demographics
NPI:1932341070
Name:FUGLEBERG CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:FUGLEBERG CHIROPRACTIC, PA
Other - Org Name:LIFESTYLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FUGLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-406-4454
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:651-406-4454
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:651-406-4454
Practice Address - Fax:651-406-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty