Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5242118-1202 | UT |
NPI | 1427269166 |
---|---|
Provider Name | Jace H Ferguson |
First Address | Hyde Park, UT 84318-4111 |
Second Address | Hyde Park, UT 84318-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |