Provider Demographics
NPI:1891746376
Name:NUGENT, THOMAS JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:NUGENT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:T.J.
Other - Middle Name:
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2931 MANOR DR.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-835-8330
Mailing Address - Fax:989-835-4906
Practice Address - Street 1:2931 MANOR DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4452
Practice Address - Country:US
Practice Address - Phone:989-835-8330
Practice Address - Fax:989-835-4906
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E6 5001Medicare ID - Type Unspecified