Provider Demographics
NPI:1265667836
Name:FERGUSON, SAMMIE JO (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMMIE
Middle Name:JO
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SAMMIE
Other - Middle Name:JO
Other - Last Name:VASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1107 E 13TH ST., SUITES A&B
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-7956
Mailing Address - Country:US
Mailing Address - Phone:918-786-8834
Mailing Address - Fax:918-786-6520
Practice Address - Street 1:1107 E 13TH ST., SUITES A&B
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7956
Practice Address - Country:US
Practice Address - Phone:918-786-8834
Practice Address - Fax:918-786-6520
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK103143Medicare PIN