Provider Demographics
NPI:1770510646
Name:FERGUSON, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:2250 W 86TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1965
Mailing Address - Country:US
Mailing Address - Phone:317-876-7826
Mailing Address - Fax:317-893-7157
Practice Address - Street 1:2250 W 86TH ST
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1965
Practice Address - Country:US
Practice Address - Phone:317-876-7826
Practice Address - Fax:317-893-7157
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100216870AMedicaid
INU32494Medicare UPIN
IN713280Medicare ID - Type Unspecified