Healthcare Provider Details

I. General information

NPI: 1801292024
Provider Name (Legal Business Name): JILLIAN LEIGH CAMERON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN LEIGH CAMERON DC

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E VALLEY RD UNIT 202A
BASALT CO
81621-8370
US

IV. Provider business mailing address

711 E VALLEY RD UNIT 202A
BASALT CO
81621-8370
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-9204
  • Fax:
Mailing address:
  • Phone: 970-927-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12772
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0007490
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: