Provider Demographics
NPI:1710979380
Name:SUTTER, CAMERON EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:EDWARD
Last Name:SUTTER
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 1:10175 RANCHO CARMEL DR
Mailing Address - Street 2:#116
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3675
Mailing Address - Country:US
Mailing Address - Phone:858-674-6400
Mailing Address - Fax:858-674-6498
Practice Address - Street 1:10175 RANCHO CARMEL DR
Practice Address - Street 2:#116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3675
Practice Address - Country:US
Practice Address - Phone:858-674-6400
Practice Address - Fax:858-674-6498
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05962Medicare UPIN
CADC29627Medicare ID - Type Unspecified