Provider Demographics
NPI:1326360587
Name:KHAVARIMANESH, CAMERON REZA (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:REZA
Last Name:KHAVARIMANESH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CAMERON
Other - Middle Name:REZA
Other - Last Name:KHAVARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4001 E MOUNTAIN SKY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3743
Mailing Address - Country:US
Mailing Address - Phone:480-619-2020
Mailing Address - Fax:480-436-5800
Practice Address - Street 1:4417 N 40TH ST STE 400A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:480-619-2020
Practice Address - Fax:480-436-5800
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor