Provider Demographics
NPI:1831273739
Name:FUGITT, ROBERT WILLIS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIS
Last Name:FUGITT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1712
Mailing Address - Country:US
Mailing Address - Phone:916-366-5500
Mailing Address - Fax:916-366-6710
Practice Address - Street 1:9700 BUSINESS PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1712
Practice Address - Country:US
Practice Address - Phone:916-366-5500
Practice Address - Fax:916-366-6710
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17140111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU0377Medicare UPIN
CADC0171400Medicare ID - Type Unspecified