Provider Demographics
NPI:1558722009
Name:CAMPBELL, DILLON (MS, LAT, ATC, NREMT)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MS, LAT, ATC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 KLONDIKE PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8311
Mailing Address - Country:US
Mailing Address - Phone:720-219-3929
Mailing Address - Fax:
Practice Address - Street 1:620 STILES AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31415-5365
Practice Address - Country:US
Practice Address - Phone:720-219-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB202103473146N00000X
COQ161562146N00000X
COAT.00018692255A2300X
GAAT0041592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic