Provider Demographics
NPI:1265616965
Name:FERGUSON, LELAND (DC)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:
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 1:4861 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1610
Mailing Address - Country:US
Mailing Address - Phone:858-458-5144
Mailing Address - Fax:858-458-5950
Practice Address - Street 1:4861 CONVOY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1610
Practice Address - Country:US
Practice Address - Phone:858-458-5144
Practice Address - Fax:858-458-5950
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor