Provider Demographics
NPI:1487008272
Name:MACKICHAN, CAMERON ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:ROBERT
Last Name:MACKICHAN
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 1:2003 ROUND BARN RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6828
Mailing Address - Country:US
Mailing Address - Phone:217-281-0006
Mailing Address - Fax:217-903-4152
Practice Address - Street 1:2003 ROUND BARN RD STE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6828
Practice Address - Country:US
Practice Address - Phone:217-281-0006
Practice Address - Fax:217-903-4152
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor