Provider Demographics
NPI:1255504296
Name:CAMPBELL, BHAIRD A (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:BHAIRD
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
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Mailing Address - Street 1:91 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2571
Mailing Address - Country:US
Mailing Address - Phone:978-369-9400
Mailing Address - Fax:978-369-9400
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2571
Practice Address - Country:US
Practice Address - Phone:978-369-9400
Practice Address - Fax:978-369-9400
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA230158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist