Provider Demographics
NPI:1497463855
Name:CAMPOS, JUSTIN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHRISTOPHER
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 FOXSPRINGS DR APT D
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-0703
Mailing Address - Country:US
Mailing Address - Phone:808-377-0703
Mailing Address - Fax:
Practice Address - Street 1:2000 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1647
Practice Address - Country:US
Practice Address - Phone:636-434-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008596111N00000X
IL038.013669111N00000X
MO2021003453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor