Provider Demographics
NPI:1871119883
Name:CAMACHO, SKYLAR DIAN (DC)
Entity type:Individual
Prefix:MRS
First Name:SKYLAR
Middle Name:DIAN
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E DEBBIE LN STE 104
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8575
Mailing Address - Country:US
Mailing Address - Phone:817-934-7816
Mailing Address - Fax:
Practice Address - Street 1:1560 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8574
Practice Address - Country:US
Practice Address - Phone:817-934-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114433OtherCHIROPRACTIC