MEDICARE: DR. KERRIE L FERGUSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X011223	NY

General Provider Information

NPI Number	:	1043268311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRIE L FERGUSON DC

Provider Business Mailing Address
First Line	:	5353 MAIN ST
Second Line	:	SUITE 4
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5337
Country	:	US
Telephone Number	:	716-984-0925
Fax Number	:	716-626-4401

Provider Business Practice Location Address
First Line	:	5353 MAIN ST
Second Line	:	SUITE 4
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5337
Country	:	US
Telephone Number	:	716-984-0925
Fax Number	:	716-626-4401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/03/2008

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