Provider Demographics
NPI:1366474967
Name:FERGUSON, CAMILLA (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 MARSETTA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2733
Mailing Address - Country:US
Mailing Address - Phone:937-429-4445
Mailing Address - Fax:937-429-4447
Practice Address - Street 1:1526 MARSETTA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2733
Practice Address - Country:US
Practice Address - Phone:937-429-4445
Practice Address - Fax:937-429-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020637OtherANTHEM BCBS
OH31-1559068-00OtherBWC
OH31-1559068-00OtherBWC
OH000000020637OtherANTHEM BCBS