Provider Demographics
NPI:1164575635
Name:CAMARATA, TODD ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:CAMARATA
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 1:43257 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5006
Mailing Address - Country:US
Mailing Address - Phone:586-246-8834
Mailing Address - Fax:
Practice Address - Street 1:43257 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5006
Practice Address - Country:US
Practice Address - Phone:586-246-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006654111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP03560001Medicare UPIN
MI0P03560-001Medicare ID - Type Unspecified