Healthcare Provider Details

I. General information

NPI: 1174122527
Provider Name (Legal Business Name): CAMACHO CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 FRONTIER WAY SW
MATTAWA WA
99349-2092
US

IV. Provider business mailing address

127 FRONTIER WAY SW
MATTAWA WA
99349-2092
US

V. Phone/Fax

Practice location:
  • Phone: 509-203-7666
  • Fax: 509-203-7664
Mailing address:
  • Phone: 509-203-7666
  • Fax: 509-203-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN RAMON CAMACHO
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 509-305-5163