Provider Demographics
NPI:1821211640
Name:CAMPBELL, BRANDON P (DC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:P
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 1:4303 W. 27TH AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-783-0834
Mailing Address - Fax:509-987-1090
Practice Address - Street 1:4303 W. 27TH AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-783-0834
Practice Address - Fax:509-987-1090
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA889646Medicare PIN