Provider Demographics
NPI:1255345617
Name:FERGUSON, DEAN EMIL (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:EMIL
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:E
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:690 EAST BRIDGE STREET
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-0028
Mailing Address - Country:US
Mailing Address - Phone:563-245-1151
Mailing Address - Fax:563-245-1186
Practice Address - Street 1:690 EAST BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-0028
Practice Address - Country:US
Practice Address - Phone:563-245-1151
Practice Address - Fax:563-245-1186
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
229331OtherMIDLANDS CHOICE
21216OtherWELLMARK BCBS
IA1212167Medicaid
T01201Medicare UPIN
IA1212167Medicaid