Provider Demographics
NPI:1922343706
Name:CAMACHO, JONNATHAN ALBERTO (DC)
Entity Type:Individual
Prefix:MR
First Name:JONNATHAN
Middle Name:ALBERTO
Last Name:CAMACHO
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 1:18857 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8201
Mailing Address - Country:US
Mailing Address - Phone:305-371-3339
Mailing Address - Fax:305-371-8966
Practice Address - Street 1:18857 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8201
Practice Address - Country:US
Practice Address - Phone:214-907-6611
Practice Address - Fax:813-756-8583
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR509111N00000X
FLCH112187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor