Provider Demographics
NPI:1891852257
Name:CAMPBELL, SHAWN D (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
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 1:115 E 7200 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047
Mailing Address - Country:US
Mailing Address - Phone:801-733-9900
Mailing Address - Fax:801-566-4476
Practice Address - Street 1:115 E 7200 SOUTH
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-733-9900
Practice Address - Fax:801-566-4476
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176126-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT05200Medicare UPIN
UT000056118Medicare ID - Type Unspecified