MEDICARE: DR. CAMERON FANNON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15363	FL

General Provider Information

NPI Number	:	1427846708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMERON FANNON DC

Provider Business Mailing Address
First Line	:	1100 DOUGHERTY ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 E ALTAMONTE DR STE 1020
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4346
Country	:	US
Telephone Number	:	407-676-7827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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Directions to “ DR. CAMERON FANNON DC” Practice Location

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