Provider Demographics
NPI:1679527782
Name:VANCAMPEN, PHILIP ADRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ADRIAN
Last Name:VANCAMPEN
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:PO BOX 12027
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-0100
Mailing Address - Country:US
Mailing Address - Phone:910-343-1111
Mailing Address - Fax:910-343-8292
Practice Address - Street 1:3825 MARKET STREET
Practice Address - Street 2:SUITE ONE
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1401
Practice Address - Country:US
Practice Address - Phone:910-343-1111
Practice Address - Fax:910-343-8292
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08884OtherBCBS
NC8908884Medicaid
350002007OtherRR MEDICARE
T64372Medicare UPIN
NC08884OtherBCBS