Provider Demographics
NPI:1326002312
Name:FERGUSSON, JEFFREY HAROLD (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HAROLD
Last Name:FERGUSSON
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 1:3007 S HAZEL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3007 S HAZEL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5703
Practice Address - Country:US
Practice Address - Phone:870-535-5600
Practice Address - Fax:870-535-5655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59817Medicare ID - Type Unspecified
AR16972Medicare UPIN