Healthcare Provider Details

I. General information

NPI: 1962198952
Provider Name (Legal Business Name): CAMERON DWYER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 W IRONWOOD DR STE 206
COEUR D ALENE ID
83814-2668
US

IV. Provider business mailing address

980 W IRONWOOD DR STE 206
COEUR D ALENE ID
83814-2668
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-2030
  • Fax: 208-400-9537
Mailing address:
  • Phone: 208-215-2030
  • Fax: 208-400-9537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR.CH.61413649
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-2352
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: