Healthcare Provider Details

I. General information

NPI: 1437067626
Provider Name (Legal Business Name): ADRIAN CAMILLE FERGUSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LUKE ST STE C
FORT COLLINS CO
80524-4067
US

IV. Provider business mailing address

PO BOX 270
LAPORTE CO
80535-0270
US

V. Phone/Fax

Practice location:
  • Phone: 970-412-4558
  • Fax:
Mailing address:
  • Phone: 970-412-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2959
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: