Provider Demographics
NPI:1639131550
Name:CAMPBELL, TERENCE JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:JOSEPH
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 1:2513 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1912
Mailing Address - Country:US
Mailing Address - Phone:814-943-0251
Mailing Address - Fax:814-944-3660
Practice Address - Street 1:2513 BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1912
Practice Address - Country:US
Practice Address - Phone:814-943-0251
Practice Address - Fax:814-944-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001907L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006332470001Medicaid
PAT28474Medicare UPIN
PA0000094106Medicare ID - Type Unspecified