Provider Demographics
NPI:1851477715
Name:FERGUSON, CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
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 1:11065 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-6253
Mailing Address - Country:US
Mailing Address - Phone:402-533-4410
Mailing Address - Fax:
Practice Address - Street 1:15763 CW HADAN DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007
Practice Address - Country:US
Practice Address - Phone:402-238-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063669803Medicaid
NEP00411310OtherRR MEDICARE
NEDG0483OtherRR MEDICARE GROUP
NE278969Medicare ID - Type Unspecified
NEP00411310OtherRR MEDICARE