Basic Information
| Provider Information | |||||||||
| NPI: | 1831792027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEAVELAND | ||||||||
| FirstName: | CAMI | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | D.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 GRANITE ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021845350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819613370 | ||||||||
| FaxNumber: | 7819611291 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 CRAFTS ST STE 570 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024581282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179647900 | ||||||||
| FaxNumber: | 6179658071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 002159 | CT | N | Chiropractic Providers | Chiropractor | 111N00000X | 3722 | MA | Y | Chiropractic Providers | Chiropractor |
No ID Information.