Provider Demographics
NPI:1922115161
Name:CAMACHO, NORMA (DC)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:CAMACHO
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 1:900 GRAND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4973
Mailing Address - Country:US
Mailing Address - Phone:203-907-4667
Mailing Address - Fax:203-907-4086
Practice Address - Street 1:900 GRAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4973
Practice Address - Country:US
Practice Address - Phone:203-907-4667
Practice Address - Fax:203-907-4086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001515OtherLICENSE
050001515CT01OtherANTHEM
1046062OtherCIGNA
1046062OtherUNITED HEALTHCARE