Provider Demographics
NPI:1215113451
Name:REAGAN, CAMILLE CATHERINE (DC)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:CATHERINE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:CATHERINE
Other - Last Name:EBERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13396 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5208
Mailing Address - Country:US
Mailing Address - Phone:972-503-7272
Mailing Address - Fax:413-280-8766
Practice Address - Street 1:13396 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5208
Practice Address - Country:US
Practice Address - Phone:972-503-7272
Practice Address - Fax:413-280-8766
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9065111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194908210OtherGROUP NPI
TX0016QUOtherBCBS GROUP NUMBER
8AT940OtherBCBS PROVIDER NUMBER