Provider Demographics
NPI:1164654075
Name:CAMPOLA CHIROPRACTIC SERVICES P.C.
Entity Type:Organization
Organization Name:CAMPOLA CHIROPRACTIC SERVICES P.C.
Other - Org Name:URGENT CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRATARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CAMPOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:315-793-7455
Mailing Address - Street 1:1904 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5662
Mailing Address - Country:US
Mailing Address - Phone:315-793-7455
Mailing Address - Fax:866-376-6307
Practice Address - Street 1:1904 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5662
Practice Address - Country:US
Practice Address - Phone:315-793-7455
Practice Address - Fax:866-376-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009085-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU74203Medicare UPIN