Provider Demographics
NPI:1770016370
Name:CAMPA, JENNIFER (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CAMPA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GROCE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1631
Mailing Address - Country:US
Mailing Address - Phone:864-439-1345
Mailing Address - Fax:864-439-1346
Practice Address - Street 1:12 GROCE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1631
Practice Address - Country:US
Practice Address - Phone:864-439-1345
Practice Address - Fax:864-439-1346
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4739111N00000X
SC4204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor