Healthcare Provider Details

I. General information

NPI: 1174817944
Provider Name (Legal Business Name): LORI L UGOLIK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TAHOA BLVD CHIROPRACTIC 923 TAHOE BLVD STE. 110 C
INCLINE VILLAGE NV
89451
US

IV. Provider business mailing address

1095 HOOTEN DR.
SILVER SPRINGS NV
89429
US

V. Phone/Fax

Practice location:
  • Phone: 775-426-9296
  • Fax: 478-743-2402
Mailing address:
  • Phone: 775-426-9296
  • Fax: 478-743-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005023
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01637
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: