Provider Demographics
NPI:1619334612
Name:FERGUSON HEALTH LLC
Entity Type:Organization
Organization Name:FERGUSON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-624-1448
Mailing Address - Street 1:9955 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1914
Mailing Address - Country:US
Mailing Address - Phone:239-631-8156
Mailing Address - Fax:239-631-8159
Practice Address - Street 1:9955 TAMIAMI TRL N
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1914
Practice Address - Country:US
Practice Address - Phone:239-631-8156
Practice Address - Fax:239-631-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty