Provider Demographics
NPI:1174655849
Name:CAMPBELL, DALE EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EUGENE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:PROF
Other - First Name:DALE
Other - Middle Name:EUGENE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC,
Mailing Address - Street 1:343 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4314
Mailing Address - Country:US
Mailing Address - Phone:419-281-7172
Mailing Address - Fax:
Practice Address - Street 1:2680 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1734
Practice Address - Country:US
Practice Address - Phone:330-345-7188
Practice Address - Fax:330-345-4334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH821111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0430046Medicaid
OH0482371Medicare ID - Type Unspecified