Provider Demographics
NPI:1639482227
Name:DOUGLAS L CAMPBELL D.C, P.C
Entity Type:Organization
Organization Name:DOUGLAS L CAMPBELL D.C, P.C
Other - Org Name:CAMPBELL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-968-9355
Mailing Address - Street 1:2 MICHIGAN AVE W
Mailing Address - Street 2:STE 200
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3609
Mailing Address - Country:US
Mailing Address - Phone:269-968-9355
Mailing Address - Fax:269-968-9366
Practice Address - Street 1:2 MICHIGAN AVE W
Practice Address - Street 2:STE 200
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3609
Practice Address - Country:US
Practice Address - Phone:269-968-9355
Practice Address - Fax:269-968-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION48090Medicare PIN
MIU89618Medicare UPIN