Provider Demographics
NPI:1225011174
Name:FEREZY, JOSEPH S (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:FEREZY
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 1:1440 HANNAH LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8653
Mailing Address - Country:US
Mailing Address - Phone:515-635-0975
Mailing Address - Fax:515-978-6198
Practice Address - Street 1:1440 HANNAH LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8653
Practice Address - Country:US
Practice Address - Phone:515-635-0975
Practice Address - Fax:515-978-6198
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05676111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42-1400619OtherTAX ID