Healthcare Provider Details

I. General information

NPI: 1396072856
Provider Name (Legal Business Name): CAMRON CHALMERS DUNN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 03/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 NE 27TH ST STE J
MCMINNVILLE OR
97128-2347
US

IV. Provider business mailing address

PO BOX 426
MCMINNVILLE OR
97128-0426
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-1738
  • Fax:
Mailing address:
  • Phone: 503-434-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16243
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: