Provider Demographics
NPI:1033687132
Name:VAN DEN BERG, CAMERON CORY (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:CORY
Last Name:VAN DEN BERG
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 1:1013 LAKE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5002
Mailing Address - Country:US
Mailing Address - Phone:208-263-2247
Mailing Address - Fax:
Practice Address - Street 1:1013 LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5002
Practice Address - Country:US
Practice Address - Phone:208-263-2247
Practice Address - Fax:208-263-2268
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor