Provider Demographics
NPI:1497769954
Name:CAMPO, KEVIN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:CAMPO
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 1:381 GARDINERS AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3701
Mailing Address - Country:US
Mailing Address - Phone:516-731-8848
Mailing Address - Fax:516-731-8335
Practice Address - Street 1:381 GARDINERS AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3701
Practice Address - Country:US
Practice Address - Phone:516-731-8848
Practice Address - Fax:516-731-8335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08428 7OtherWORKERS COMPENSATION BOAR
NYX81061Medicare PIN
U68369Medicare UPIN
NY6448270001Medicare NSC