Provider Demographics
NPI:1861637035
Name:DR NATHAN CAMPBELL
Entity Type:Organization
Organization Name:DR NATHAN CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-229-9613
Mailing Address - Street 1:4747 E ELLIOT RD
Mailing Address - Street 2:SUITE 32
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1627
Mailing Address - Country:US
Mailing Address - Phone:480-893-8700
Mailing Address - Fax:480-893-1300
Practice Address - Street 1:4747 E ELLIOT RD
Practice Address - Street 2:SUITE 32
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1627
Practice Address - Country:US
Practice Address - Phone:480-893-8700
Practice Address - Fax:480-893-1300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTUS SPORTS CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-02
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty