Provider Demographics
NPI:1679521348
Name:FERGUSON, CHESTER L (DC)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 MAIN ST
Mailing Address - Street 2:P.O. BOX 1147
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8845
Mailing Address - Country:US
Mailing Address - Phone:803-408-0965
Mailing Address - Fax:803-408-0966
Practice Address - Street 1:2547 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8845
Practice Address - Country:US
Practice Address - Phone:803-408-0965
Practice Address - Fax:803-408-0966
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0958Medicaid