Healthcare Provider Details

I. General information

NPI: 1528778297
Provider Name (Legal Business Name): THOAN FERGUSON RN, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MELISSA THOAN FERGUSON

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 08/23/2023
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 B STREET SUITE 201
HAYWARD CA
94541
US

IV. Provider business mailing address

19177 MADISON AVENUE
CASTRO VALLEY CA
94546-3560
US

V. Phone/Fax

Practice location:
  • Phone: 510-566-5604
  • Fax:
Mailing address:
  • Phone: 408-390-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36366
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number36366DC
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number527930RN
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number527930RN
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36366DC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: