Provider Demographics
NPI:1043268311
Name:FERGUSON, KERRIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KERRIE
Other - Middle Name:L
Other - Last Name:KROL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5353 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5337
Mailing Address - Country:US
Mailing Address - Phone:716-984-0925
Mailing Address - Fax:716-626-4401
Practice Address - Street 1:5353 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5337
Practice Address - Country:US
Practice Address - Phone:716-984-0925
Practice Address - Fax:716-626-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor