Provider Demographics
NPI:1225480221
Name:GENTILE, CAMERON (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:GENTILE
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 1:15077 SANTA LUCIA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3629
Mailing Address - Country:US
Mailing Address - Phone:704-779-8796
Mailing Address - Fax:
Practice Address - Street 1:15077 SANTA LUCIA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3629
Practice Address - Country:US
Practice Address - Phone:704-779-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4655111N00000X
SC4158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor