Provider Demographics
NPI:1073544979
Name:CAMPOS, NICOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
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 1:1042 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6103
Mailing Address - Country:US
Mailing Address - Phone:323-359-1032
Mailing Address - Fax:
Practice Address - Street 1:1042 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6103
Practice Address - Country:US
Practice Address - Phone:323-651-2464
Practice Address - Fax:323-651-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27396111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27396Medicare ID - Type Unspecified