Provider Demographics
NPI:1174122527
Name:CAMACHO CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:CAMACHO CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-305-5163
Mailing Address - Street 1:127 FRONTIER WAY SW
Mailing Address - Street 2:
Mailing Address - City:MATTAWA
Mailing Address - State:WA
Mailing Address - Zip Code:99349-2092
Mailing Address - Country:US
Mailing Address - Phone:509-203-7666
Mailing Address - Fax:509-203-7664
Practice Address - Street 1:127 FRONTIER WAY SW
Practice Address - Street 2:
Practice Address - City:MATTAWA
Practice Address - State:WA
Practice Address - Zip Code:99349-2092
Practice Address - Country:US
Practice Address - Phone:509-203-7666
Practice Address - Fax:509-203-7664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMACHO CHIROPRACTIC AND SPORTS MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty