Provider Demographics
NPI:1134136682
Name:CAMPBELL, CHARLES A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 MAGNOLIA COVE DR
Mailing Address - Street 2:STE 108
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2252
Mailing Address - Country:US
Mailing Address - Phone:281-358-7777
Mailing Address - Fax:281-358-8780
Practice Address - Street 1:1434 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3040
Practice Address - Country:US
Practice Address - Phone:281-358-7777
Practice Address - Fax:281-358-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83V121OtherBC/BS
TX83V121Medicare PIN