Healthcare Provider Details

I. General information

NPI: 1255666715
Provider Name (Legal Business Name): FUGATE FAMILY CHIROPRACTIC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VETERANS DR
HAZARD KY
41701-9483
US

IV. Provider business mailing address

100 VETERANS DR
HAZARD KY
41701-9483
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-3399
  • Fax: 606-487-9280
Mailing address:
  • Phone: 606-439-3399
  • Fax: 606-487-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FAIRLENA KAY FUGATE
Title or Position: OWNER
Credential: D.C.
Phone: 606-439-3399