Healthcare Provider Details

I. General information

NPI: 1851873707
Provider Name (Legal Business Name): FERGUSONCHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3993 ELATI ST
DENVER CO
80216-4832
US

IV. Provider business mailing address

2130 JULIAN ST
DENVER CO
80211-5025
US

V. Phone/Fax

Practice location:
  • Phone: 720-819-6964
  • Fax:
Mailing address:
  • Phone: 585-755-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0007762
License Number StateCO

VIII. Authorized Official

Name: TAYLOR FERGUSON
Title or Position: CHIROPRACTOR
Credential: DC, MS
Phone: 585-755-9808