Provider Demographics
NPI:1467591297
Name:DUDLEY, CAMERON MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MITCHELL
Last Name:DUDLEY
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 1:7240 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8356
Mailing Address - Country:US
Mailing Address - Phone:702-453-0440
Mailing Address - Fax:702-453-0550
Practice Address - Street 1:7240 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8356
Practice Address - Country:US
Practice Address - Phone:702-453-0440
Practice Address - Fax:702-453-0550
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3602060Medicaid
NV3602060Medicaid
NVVWJBCX02Medicare PIN
NVVWJBCXMedicare PIN