Provider Demographics
NPI:1851514905
Name:CAMPBELL, WENDY ALAYNE (DC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ALAYNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:ALAYNE
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:9536 STONEWALL CT
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95315
Mailing Address - Country:US
Mailing Address - Phone:209-656-0342
Mailing Address - Fax:
Practice Address - Street 1:1208 FLOYD AVE
Practice Address - Street 2:B6
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-549-8090
Practice Address - Fax:209-549-8094
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0207420Medicaid
DC0207420Medicare ID - Type Unspecified
CADC0207420Medicaid