Provider Demographics
NPI:1003041153
Name:CAMPOS, JORGE ALBERTO (DC)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:CAMPOS
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 1:1101 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5324
Mailing Address - Country:US
Mailing Address - Phone:563-370-1342
Mailing Address - Fax:
Practice Address - Street 1:2636 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5240
Practice Address - Country:US
Practice Address - Phone:309-762-3888
Practice Address - Fax:309-762-6888
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor