Provider Demographics
NPI:1659061265
Name:CAMACHO, EVERARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:EVERARDO
Middle Name:
Last Name:CAMACHO
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 1:117 E GRANADA CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3219
Mailing Address - Country:US
Mailing Address - Phone:626-602-6138
Mailing Address - Fax:
Practice Address - Street 1:2079 S ATLANTIC BLVD STE D
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6368
Practice Address - Country:US
Practice Address - Phone:626-602-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor