Provider Demographics
NPI:1679622088
Name:CAMPBELL, PAUL M (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
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 1:1132B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9432
Mailing Address - Country:US
Mailing Address - Phone:270-524-5240
Mailing Address - Fax:270-524-5241
Practice Address - Street 1:1132B MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9432
Practice Address - Country:US
Practice Address - Phone:270-524-5240
Practice Address - Fax:270-524-5241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU59917Medicare UPIN