Individual
MR. JALEN FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3526 S BROADWAY AVE, TYLER, TX 75701-8707
(678) 761-3497
Mailing address
11345 PREAKNESS DR, FLINT, TX 75762-6313
(678) 761-3497
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104557937
VA
111NP0017X
Pediatric Chiropractor
0104557937
VA
111NS0005X
Sports Physician Chiropractor
0104557937
VA
Other
Enumeration date
09/26/2023
Last updated
06/06/2024
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