Provider Demographics
NPI:1174861496
Name:FERGUSON FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:FERGUSON FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:BRIAN P. FERGUSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-936-3082
Mailing Address - Street 1:3313 LEE ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4735
Mailing Address - Country:US
Mailing Address - Phone:330-493-7970
Mailing Address - Fax:330-493-7410
Practice Address - Street 1:3313 LEE ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4735
Practice Address - Country:US
Practice Address - Phone:330-493-7970
Practice Address - Fax:330-493-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3764111N00000X
OH4135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty