Provider Demographics
NPI:1740942275
Name:FAIRCLOTH, CAMILLE (DC)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:FAIRCLOTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:FAIRCLOTH
Other - Last Name:NOREM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11 HEYMAN LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3574
Mailing Address - Country:US
Mailing Address - Phone:318-448-8462
Mailing Address - Fax:318-448-8486
Practice Address - Street 1:11 HEYMAN LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3574
Practice Address - Country:US
Practice Address - Phone:318-448-8462
Practice Address - Fax:318-448-8486
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA1942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program