Healthcare Provider Details

I. General information

NPI: 1750230843
Provider Name (Legal Business Name): ROOTED CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 BARTON BLVD STE 8
ROCKLEDGE FL
32955-3100
US

IV. Provider business mailing address

566 BARTON BLVD STE 8
ROCKLEDGE FL
32955-3100
US

V. Phone/Fax

Practice location:
  • Phone: 321-208-8372
  • Fax: 407-650-2837
Mailing address:
  • Phone: 901-491-4568
  • Fax: 407-650-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOIRIAN FUGH
Title or Position: CO- OWNER
Credential: DC
Phone: 901-491-4568