Provider Demographics
NPI:1700864477
Name:FERGUSON, WILLIAM VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VINCENT
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 1:812 WEST 181 STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4543
Mailing Address - Country:US
Mailing Address - Phone:212-569-0557
Mailing Address - Fax:212-740-2005
Practice Address - Street 1:812 WEST 181 STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4543
Practice Address - Country:US
Practice Address - Phone:212-569-0557
Practice Address - Fax:212-740-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX000772-1111N00000X
NYX0007721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X04501Medicare UPIN
NYX04501Medicare ID - Type Unspecified
T51721Medicare UPIN