Healthcare Provider Details

I. General information

NPI: 1710979380
Provider Name (Legal Business Name): CAMERON EDWARD SUTTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 RANCHO BERNARDO RD STE 110
SAN DIEGO CA
92127-5702
US

IV. Provider business mailing address

10805 RANCHO BERNARDO RD STE 110
SAN DIEGO CA
92127-5702
US

V. Phone/Fax

Practice location:
  • Phone: 858-674-6400
  • Fax:
Mailing address:
  • Phone: 858-674-6400
  • Fax: 858-674-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: