Provider Demographics
NPI:1023374683
Name:CAMPBELLSVILLE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CAMPBELLSVILLE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-789-0033
Mailing Address - Street 1:605 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1830
Mailing Address - Country:US
Mailing Address - Phone:270-789-0033
Mailing Address - Fax:270-789-0038
Practice Address - Street 1:605 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1830
Practice Address - Country:US
Practice Address - Phone:270-789-0033
Practice Address - Fax:270-789-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty