Provider Demographics
NPI:1063537439
Name:FERGUSON, KIRSTEN ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ELLEN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3042
Mailing Address - Country:US
Mailing Address - Phone:502-231-8068
Mailing Address - Fax:502-231-8069
Practice Address - Street 1:6521 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3042
Practice Address - Country:US
Practice Address - Phone:502-231-8068
Practice Address - Fax:502-231-8069
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041770Medicare UPIN
KYU65928Medicare ID - Type Unspecified