Provider Demographics
NPI:1740744127
Name:BAVENDER, KAMERON LEE (DC)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:LEE
Last Name:BAVENDER
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 1:2115 STEPHENS PL STE 700
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2162
Mailing Address - Country:US
Mailing Address - Phone:830-214-6423
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 700
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2162
Practice Address - Country:US
Practice Address - Phone:830-214-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor