Provider Demographics
NPI:1063582476
Name:CAMERON, GREGORY A (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:CAMERON
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 1:1201 HOWARD AVE
Mailing Address - Street 2:#101A
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4242
Mailing Address - Country:US
Mailing Address - Phone:650-340-8900
Mailing Address - Fax:650-340-8652
Practice Address - Street 1:1201 HOWARD AVE
Practice Address - Street 2:#101A
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4242
Practice Address - Country:US
Practice Address - Phone:650-340-8900
Practice Address - Fax:650-340-8652
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC014885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
94 2912847OtherTAXPAYER ID