Provider Demographics
NPI:1073710265
Name:NUGENT, JEANIE B (DC)
Entity type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:B
Last Name:NUGENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:BARBARA
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 2701
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-2701
Mailing Address - Country:US
Mailing Address - Phone:208-699-8185
Mailing Address - Fax:208-518-1255
Practice Address - Street 1:1130 W HAYDEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8720
Practice Address - Country:US
Practice Address - Phone:208-699-8185
Practice Address - Fax:208-518-1255
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU83534Medicare UPIN