Provider Demographics
NPI:1417269085
Name:CAMPBELL, LIZA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LIZA
Other - Middle Name:MARIE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-0608
Mailing Address - Country:US
Mailing Address - Phone:812-275-4419
Mailing Address - Fax:812-275-8044
Practice Address - Street 1:3525 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5558
Practice Address - Country:US
Practice Address - Phone:812-275-4419
Practice Address - Fax:812-275-8044
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002520A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871640AMedicaid