Provider Demographics
NPI:1528197506
Name:CAMPO, KENNETH JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
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 1:16 E 40TH ST
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0113
Mailing Address - Country:US
Mailing Address - Phone:212-308-6298
Mailing Address - Fax:718-236-0141
Practice Address - Street 1:16 E 40TH ST
Practice Address - Street 2:SUITE 1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0113
Practice Address - Country:US
Practice Address - Phone:212-308-6298
Practice Address - Fax:718-236-0141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8626111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4P441Medicare ID - Type Unspecified
NYU88218Medicare UPIN