Healthcare Provider Details

I. General information

NPI: 1750960209
Provider Name (Legal Business Name): JOSEPH EDWARD FERGUSON III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JONES ST APT 311
SAN FRANCISCO CA
94109-3203
US

IV. Provider business mailing address

1401 JONES ST APT 311
SAN FRANCISCO CA
94109-3203
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-1415
  • Fax:
Mailing address:
  • Phone: 415-563-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number21318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: