Provider Demographics
NPI:1346398880
Name:DRS CAMPANELLA & OLIVACZ PA
Entity Type:Organization
Organization Name:DRS CAMPANELLA & OLIVACZ PA
Other - Org Name:HAVRE DE GRACE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-939-4488
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-0180
Mailing Address - Country:US
Mailing Address - Phone:410-939-4488
Mailing Address - Fax:410-939-4498
Practice Address - Street 1:225 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2905
Practice Address - Country:US
Practice Address - Phone:410-939-4488
Practice Address - Fax:410-939-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD775MMedicare PIN