Provider Demographics
NPI:1386792935
Name:FERGUSON, JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
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 1:7350 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9560
Mailing Address - Country:US
Mailing Address - Phone:270-844-8162
Mailing Address - Fax:270-697-7980
Practice Address - Street 1:724B BARRETT BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4931
Practice Address - Country:US
Practice Address - Phone:270-844-8162
Practice Address - Fax:866-431-9813
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003556Medicaid
KY000000362192OtherANTHEM BLUE CROSS
KY6105101Medicare ID - Type Unspecified
KY85003556Medicaid