Provider Demographics
NPI:1841353224
Name:FERGUSON, SUSAN (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4725
Mailing Address - Country:US
Mailing Address - Phone:978-851-9055
Mailing Address - Fax:978-851-9033
Practice Address - Street 1:1501 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4725
Practice Address - Country:US
Practice Address - Phone:978-851-9055
Practice Address - Fax:978-851-9033
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858852OtherHCVM
MA351289OtherHPHC
MA646572OtherACN
MAY36639OtherBCBS OF MA
MA351289OtherHPHC
MAY45332Medicare PIN