Provider Demographics
NPI:1780860254
Name:CAMPBELL CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:CAMPBELL CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-663-8365
Mailing Address - Street 1:3750 DACORO LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2501
Mailing Address - Country:US
Mailing Address - Phone:303-663-8365
Mailing Address - Fax:
Practice Address - Street 1:3750 DACORO LN
Practice Address - Street 2:SUITE 135
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2501
Practice Address - Country:US
Practice Address - Phone:303-663-8365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4418OtherMEDICARE PTAN
COCOB4418OtherMEDICARE PTAN