Provider Demographics
NPI:1861503963
Name:ROE, CAMERON WADE (DC)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:WADE
Last Name:ROE
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 1:100 S POWELL PKWY
Mailing Address - Street 2:DOCTOR CAMERON ROE
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-3599
Mailing Address - Country:US
Mailing Address - Phone:972-924-2286
Mailing Address - Fax:972-924-4688
Practice Address - Street 1:100 S POWELL PKWY
Practice Address - Street 2:ANNA CHIROPRACTIC CENTER
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-3599
Practice Address - Country:US
Practice Address - Phone:972-924-2286
Practice Address - Fax:972-924-4688
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2184755Medicaid
TX613063Medicare UPIN
234435101Medicare ID - Type Unspecified