Provider Demographics
NPI:1215016613
Name:CAMPBELL, AMANDA J (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HUTCHINGS ST
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-2425
Mailing Address - Country:US
Mailing Address - Phone:325-648-3103
Mailing Address - Fax:325-648-2959
Practice Address - Street 1:1101 HUTCHINGS ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2425
Practice Address - Country:US
Practice Address - Phone:325-648-3103
Practice Address - Fax:325-648-2959
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor