Provider Demographics
NPI:1730959610
Name:GORDINEER, CAMERON (DC)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:GORDINEER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 HARBOR MILL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-3241
Mailing Address - Country:US
Mailing Address - Phone:570-578-3868
Mailing Address - Fax:
Practice Address - Street 1:4949 AUTUMN OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8557
Practice Address - Country:US
Practice Address - Phone:757-774-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor