Provider Demographics
NPI:1588711204
Name:FERN CREEK CHIROPRACTIC CENTER, PSC
Entity type:Organization
Organization Name:FERN CREEK CHIROPRACTIC CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-231-8068
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4383111N00000X
KY4361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041769Medicare UPIN
KY000000041770Medicare UPIN
KY000000055819Medicare UPIN
KYU65928Medicare ID - Type UnspecifiedDR. KIRSTEN FERGUSON, D.C
KYU65929Medicare ID - Type UnspecifiedDR. MARK HOFFMAN, D.C.