Provider Demographics
NPI:1154359362
Name:COLE, JACQUELYN FERGUSON (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:FERGUSON
Last Name:COLE
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 1:2025 FLOUR BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5309
Mailing Address - Country:US
Mailing Address - Phone:361-937-1215
Mailing Address - Fax:361-937-1438
Practice Address - Street 1:10235 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-4454
Practice Address - Country:US
Practice Address - Phone:361-937-1215
Practice Address - Fax:361-937-1438
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT84764Medicare UPIN
TX603032Medicare ID - Type Unspecified