Provider Demographics
NPI:1689857708
Name:FERGUSON, NICOLE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 LYON ST
Mailing Address - Street 2:
Mailing Address - City:JEWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50130-1024
Mailing Address - Country:US
Mailing Address - Phone:515-827-9008
Mailing Address - Fax:
Practice Address - Street 1:717 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWELL
Practice Address - State:IA
Practice Address - Zip Code:50130
Practice Address - Country:US
Practice Address - Phone:515-827-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor