Provider Demographics
NPI:1619083821
Name:CAMPBELL, MONTE TODD (DC)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:TODD
Last Name:CAMPBELL
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 1:206 S MAIN
Mailing Address - Street 2:STE B
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-743-4340
Mailing Address - Fax:405-372-7000
Practice Address - Street 1:206 S MAIN
Practice Address - Street 2:STE B
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-743-4340
Practice Address - Fax:405-372-7000
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57690Medicare UPIN