Provider Demographics
NPI:1467949545
Name:DECAMP, CRAIG RICHARD (CPO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RICHARD
Last Name:DECAMP
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5122
Mailing Address - Country:US
Mailing Address - Phone:765-463-4100
Mailing Address - Fax:765-463-4112
Practice Address - Street 1:2041 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-5122
Practice Address - Country:US
Practice Address - Phone:765-463-4100
Practice Address - Fax:765-463-4112
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist