Provider Demographics
NPI:1831133388
Name:CAMPBELL, CORY M (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
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 1:3750 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:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98442Medicare UPIN
COC523048Medicare ID - Type Unspecified