Provider Demographics
NPI:1225020407
Name:CAMPBELL, KYLE CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CHRISTOPHER
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 1:1301 E END BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-6401
Mailing Address - Country:US
Mailing Address - Phone:903-938-9931
Mailing Address - Fax:903-938-9947
Practice Address - Street 1:1301 E END BLVD S
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6401
Practice Address - Country:US
Practice Address - Phone:903-938-9931
Practice Address - Fax:903-938-9947
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609018OtherBLUE CROSS BLUE SHIELD
TX088497502Medicaid
350051961OtherPALMETTO GBA
TX609018Medicare ID - Type Unspecified
TX088497502Medicaid