Provider Demographics
NPI:1558501536
Name:KAMEGO CHIROPRACTIC CLINIC L.C.
Entity Type:Organization
Organization Name:KAMEGO CHIROPRACTIC CLINIC L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAMEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-798-7500
Mailing Address - Street 1:716 N VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-8500
Mailing Address - Country:US
Mailing Address - Phone:810-798-7500
Mailing Address - Fax:810-798-7577
Practice Address - Street 1:716 N VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8500
Practice Address - Country:US
Practice Address - Phone:810-798-7500
Practice Address - Fax:810-798-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4250360 14Medicaid
MI0N14410Medicare PIN
MI4250360 14Medicaid