Provider Demographics
NPI:1891117974
Name:DR. CAMERON KHAVARI PLLC
Entity Type:Organization
Organization Name:DR. CAMERON KHAVARI PLLC
Other - Org Name:TRIMOTUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:KHAVARIMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-619-2020
Mailing Address - Street 1:4001 E MOUNTAIN SKY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3743
Mailing Address - Country:US
Mailing Address - Phone:480-619-2020
Mailing Address - Fax:480-436-5800
Practice Address - Street 1:4001 E MOUNTAIN SKY AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:480-619-2020
Practice Address - Fax:480-436-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty