Provider Demographics
NPI:1366500621
Name:CAMPBELL, CHRISTA ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:ELAINE
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 1:301 MERRITT 7
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1070
Mailing Address - Country:US
Mailing Address - Phone:203-604-0202
Mailing Address - Fax:203-604-0204
Practice Address - Street 1:301 MERRITT 7
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1070
Practice Address - Country:US
Practice Address - Phone:203-604-0202
Practice Address - Fax:203-604-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU 97457Medicare UPIN