Provider Demographics
NPI:1093343303
Name:GHOLAMPOUR, CAMERON ANDRE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:ANDRE
Last Name:GHOLAMPOUR
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 1:4416 BARDSDALE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2600
Mailing Address - Country:US
Mailing Address - Phone:727-517-6266
Mailing Address - Fax:
Practice Address - Street 1:14210 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2219
Practice Address - Country:US
Practice Address - Phone:727-517-6266
Practice Address - Fax:727-286-9644
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093343303OtherNPI