Provider Demographics
NPI:1326144106
Name:FERGUSON, JAY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:FERGUSON
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 1:1401 S WASHINGTON ST
Mailing Address - Street 2:STE E
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2474
Mailing Address - Country:US
Mailing Address - Phone:402-934-4484
Mailing Address - Fax:402-934-8937
Practice Address - Street 1:1401 S WASHINGTON ST STE E
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2474
Practice Address - Country:US
Practice Address - Phone:402-934-4484
Practice Address - Fax:402-934-8937
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor