Provider Demographics
NPI:1043774185
Name:CAMPBELL, FELICIA (DC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:CAMPBELL
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 1:928 VALLEY VIEW DR
Mailing Address - Street 2:STE 14
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5288
Mailing Address - Country:US
Mailing Address - Phone:712-828-4801
Mailing Address - Fax:712-828-4802
Practice Address - Street 1:928 VALLEY VIEW DR
Practice Address - Street 2:STE 14
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5288
Practice Address - Country:US
Practice Address - Phone:712-828-4801
Practice Address - Fax:712-828-4802
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2001111N00000X
IA101432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor