Provider Demographics
NPI:1124027354
Name:FERGUS, MICHAEL PATRICK (DC, DACBR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:FERGUS
Suffix:
Gender:M
Credentials:DC, DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13025 CONIFER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2989
Mailing Address - Country:US
Mailing Address - Phone:815-436-4986
Mailing Address - Fax:
Practice Address - Street 1:13025 CONIFER ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2989
Practice Address - Country:US
Practice Address - Phone:815-436-4986
Practice Address - Fax:815-230-2608
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008518111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932261OtherBCBS
ILK14230Medicare PIN
IL9932261OtherBCBS
ILU99794Medicare UPIN
ILF400222847Medicare PIN