Provider Demographics
NPI:1407074040
Name:CAMERON, SUSAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 BALBOA AVE
Mailing Address - Street 2:320
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2261
Mailing Address - Country:US
Mailing Address - Phone:858-627-9646
Mailing Address - Fax:858-627-9709
Practice Address - Street 1:7710 BALBOA AVE
Practice Address - Street 2:320
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2261
Practice Address - Country:US
Practice Address - Phone:858-627-9646
Practice Address - Fax:858-627-9709
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA700521Medicare UPIN