MEDICARE: DR. KIRSTEN ELLEN 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	4361	KY

General Provider Information

NPI Number	:	1063537439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN ELLEN FERGUSON DC

Provider Business Mailing Address
First Line	:	6521 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3042
Country	:	US
Telephone Number	:	502-231-8068
Fax Number	:	502-231-8069

Provider Business Practice Location Address
First Line	:	6521 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3042
Country	:	US
Telephone Number	:	502-231-8068
Fax Number	:	502-231-8069

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/09/2007

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Directions to “ DR. KIRSTEN ELLEN FERGUSON DC” Practice Location

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