Provider Demographics
NPI:1023247194
Name:HATAM, CAMERON (DC)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:HATAM
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 1:344 MAPLE AVE W
Mailing Address - Street 2:#231
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5612
Mailing Address - Country:US
Mailing Address - Phone:703-370-5300
Mailing Address - Fax:703-370-0080
Practice Address - Street 1:50 S PICKETT ST
Practice Address - Street 2:#114
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7207
Practice Address - Country:US
Practice Address - Phone:703-370-5300
Practice Address - Fax:703-370-0080
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556722111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor