Provider Demographics
NPI:1164456901
Name:CAMPBELL, DENNIS LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LYNN
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 1:620 E ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1918
Mailing Address - Country:US
Mailing Address - Phone:661-758-5131
Mailing Address - Fax:
Practice Address - Street 1:620 E ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1918
Practice Address - Country:US
Practice Address - Phone:661-758-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC180130111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0180130Medicare ID - Type Unspecified