Provider Demographics
NPI:1992953269
Name:CHARLES A. FERGESON JR. D.C., P.C.
Entity type:Organization
Organization Name:CHARLES A. FERGESON JR. D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:FERGESON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:434-447-6649
Mailing Address - Street 1:901 PACE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1307
Mailing Address - Country:US
Mailing Address - Phone:434-447-6649
Mailing Address - Fax:434-447-6649
Practice Address - Street 1:901 PACE DR
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1307
Practice Address - Country:US
Practice Address - Phone:434-447-6649
Practice Address - Fax:434-447-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104 001994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAUB7252Medicare UPIN
VA350001063Medicare PIN