Provider Demographics
NPI:1043666076
Name:CAMPBELL, BRAD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:CAMPBELL
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 1:522 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2717
Mailing Address - Country:US
Mailing Address - Phone:847-251-0044
Mailing Address - Fax:847-251-0066
Practice Address - Street 1:522 POPLAR DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2717
Practice Address - Country:US
Practice Address - Phone:847-251-0044
Practice Address - Fax:847-251-0066
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor