Provider Demographics
NPI:1679525588
Name:CAMPBELL SPORTS REHAB INC
Entity Type:Organization
Organization Name:CAMPBELL SPORTS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-630-9495
Mailing Address - Street 1:8409 N MILITARY TRL
Mailing Address - Street 2:SUITE 113
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6316
Mailing Address - Country:US
Mailing Address - Phone:561-630-9495
Mailing Address - Fax:561-253-0845
Practice Address - Street 1:8409 N MILITARY TRL
Practice Address - Street 2:SUITE 113
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6316
Practice Address - Country:US
Practice Address - Phone:561-630-9495
Practice Address - Fax:561-253-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9708Medicare PIN