=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386792935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES FERGUSON D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 03/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724B BARRETT BLVD
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42420-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-844-8162
-----------------------------------------------------
Fax | 866-431-9813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7350 AIRLINE RD
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42420-9560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-844-8162
-----------------------------------------------------
Fax | 270-697-7980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4902
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------