Provider Demographics
NPI:1710079116
Name:CAMDEN, DARREN JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:JOE
Last Name:CAMDEN
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 1:100 S. SAMPSON
Mailing Address - Street 2:PO BOX 1046
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-1046
Mailing Address - Country:US
Mailing Address - Phone:309-925-5541
Mailing Address - Fax:309-925-4204
Practice Address - Street 1:100 S. SAMPSON
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-1046
Practice Address - Country:US
Practice Address - Phone:309-925-5541
Practice Address - Fax:309-925-4204
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05391111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT90999Medicare UPIN
915361Medicare ID - Type Unspecified