Provider Demographics
NPI:1467025569
Name:CAMPBELL, KRYSTAL R (DC, LAC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 EAST AVE STE 313
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4902
Mailing Address - Country:US
Mailing Address - Phone:203-838-9795
Mailing Address - Fax:
Practice Address - Street 1:83 EAST AVE STE 313
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-838-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02203111N00000X
CT807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist