Healthcare Provider Details

I. General information

NPI: 1982206751
Provider Name (Legal Business Name): CAMERON DESROCHERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WASHINGTON ST STE 301
FALLS CHURCH VA
22046-2921
US

IV. Provider business mailing address

150 S WASHINGTON ST STE 301
FALLS CHURCH VA
22046-2921
US

V. Phone/Fax

Practice location:
  • Phone: 571-327-2213
  • Fax: 571-368-3712
Mailing address:
  • Phone: 571-327-2213
  • Fax: 571-368-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104-557700
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: