Provider Demographics
NPI:1497177653
Name:FERGUSON 'LIFE' CHIROPRACTIC CENTERS, LLC
Entity Type:Organization
Organization Name:FERGUSON 'LIFE' CHIROPRACTIC CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-210-3838
Mailing Address - Street 1:760 ROUTE 10 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1159
Mailing Address - Country:US
Mailing Address - Phone:973-210-3838
Mailing Address - Fax:
Practice Address - Street 1:760 ROUTE 10 W
Practice Address - Street 2:SUITE 205
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1159
Practice Address - Country:US
Practice Address - Phone:973-210-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC000674100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ157243Medicare PIN