Provider Demographics
NPI:1801965751
Name:FERGUSON, JON J (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:J
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 1:393 WEST U.S. HIGHWAY #36
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872
Mailing Address - Country:US
Mailing Address - Phone:765-569-3440
Mailing Address - Fax:765-569-3362
Practice Address - Street 1:393 WEST U.S. HIGHWAY #36
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872
Practice Address - Country:US
Practice Address - Phone:765-569-3440
Practice Address - Fax:765-569-3362
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000720A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100326290AMedicaid
INT34960Medicare UPIN
IN211830AMedicare ID - Type Unspecified