Provider Demographics
NPI:1528778297
Name:FERGUSON, THOAN (RN, DC)
Entity type:Individual
Prefix:DR
First Name:THOAN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN, DC
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:THOAN
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19177 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3560
Mailing Address - Country:US
Mailing Address - Phone:408-390-5554
Mailing Address - Fax:
Practice Address - Street 1:1866 B STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-566-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36366111N00000X
CA36366DC111NP0017X, 111N00000X
CA527930RN163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant