Provider Demographics
NPI:1699835124
Name:FERCH, GREGORY E (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:FERCH
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 1:6624 OVERLAND RD
Mailing Address - Street 2:GREGORY FERCH DC
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6624 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2030
Practice Address - Country:US
Practice Address - Phone:208-376-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU48547Medicare UPIN
ID1673081Medicare PIN