Provider Demographics
NPI:1801292024
Name:CAMERON, JILLIAN LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEIGH
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:LEIGH
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:711 E VALLEY RD UNIT 202A
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8370
Mailing Address - Country:US
Mailing Address - Phone:970-927-9204
Mailing Address - Fax:
Practice Address - Street 1:711 E VALLEY RD UNIT 202A
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8370
Practice Address - Country:US
Practice Address - Phone:970-927-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12772111N00000X
COCHR.0007490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor