Provider Demographics
NPI:1356458285
Name:CAMPBELL CHIROPRACTIC AND PHYSICAL MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:CAMPBELL CHIROPRACTIC AND PHYSICAL MEDICINE CENTER, LLC
Other - Org Name:ELMWOOD PHYSICAL MEDICINE AND CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-994-2030
Mailing Address - Street 1:105 WEST E ST
Mailing Address - Street 2:PO BOX 302
Mailing Address - City:ELMWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68349
Mailing Address - Country:US
Mailing Address - Phone:402-994-2030
Mailing Address - Fax:402-994-2161
Practice Address - Street 1:105 WEST E ST.
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:NE
Practice Address - Zip Code:68349
Practice Address - Country:US
Practice Address - Phone:402-994-2030
Practice Address - Fax:402-994-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty