Provider Demographics
NPI:1922421742
Name:CAMERON, ELON (MSTOM, DIPL OM)
Entity Type:Individual
Prefix:
First Name:ELON
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MSTOM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S GARFIELD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2967
Mailing Address - Country:US
Mailing Address - Phone:231-943-2328
Mailing Address - Fax:231-943-2327
Practice Address - Street 1:121 S GARFIELD AVE STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2967
Practice Address - Country:US
Practice Address - Phone:231-943-2328
Practice Address - Fax:231-943-2327
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
113585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist