Provider Demographics
NPI:1669026498
Name:BARRETT, KAMELA MIRIAH (DC)
Entity Type:Individual
Prefix:
First Name:KAMELA
Middle Name:MIRIAH
Last Name:BARRETT
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 1:170 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3729
Mailing Address - Country:US
Mailing Address - Phone:503-266-2997
Mailing Address - Fax:
Practice Address - Street 1:170 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3729
Practice Address - Country:US
Practice Address - Phone:503-266-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6030111N00000X
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes111N00000XChiropractic ProvidersChiropractor