Provider Demographics
NPI:1235147992
Name:HART, CAMERON TRACY (DC)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:TRACY
Last Name:HART
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 1:8355 UNIVERSITY BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1162
Mailing Address - Country:US
Mailing Address - Phone:515-225-4422
Mailing Address - Fax:
Practice Address - Street 1:8355 UNIVERSITY BLVD
Practice Address - Street 2:STE H
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1162
Practice Address - Country:US
Practice Address - Phone:515-225-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06753OtherWELLMARK BCBS
IAI16692Medicare UPIN