Provider Demographics
NPI:1639402779
Name:CAMPUS CLINICS, LLC
Entity Type:Organization
Organization Name:CAMPUS CLINICS, LLC
Other - Org Name:CAMPUS CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-351-2412
Mailing Address - Street 1:1901 10TH AVE
Mailing Address - Street 2:CAMPUS BOX 37
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-5545
Mailing Address - Country:US
Mailing Address - Phone:970-351-2412
Mailing Address - Fax:970-351-2427
Practice Address - Street 1:1901 10TH AVE
Practice Address - Street 2:CAMPUS BOX 37
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-5545
Practice Address - Country:US
Practice Address - Phone:970-351-2412
Practice Address - Fax:970-351-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5112111NR0400X
CO32068208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty