Provider Demographics
NPI:1982206751
Name:DESROCHERS, CAMERON (DC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:DESROCHERS
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 1:150 S WASHINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2921
Mailing Address - Country:US
Mailing Address - Phone:571-327-2213
Mailing Address - Fax:571-368-3712
Practice Address - Street 1:150 S WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-2921
Practice Address - Country:US
Practice Address - Phone:571-327-2213
Practice Address - Fax:571-368-3712
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104-557700OtherSTATE LICENSE