Provider Demographics
NPI:1902199078
Name:CAMPBELL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CAMPBELL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:RP
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-236-9355
Mailing Address - Street 1:PO BOX 1930
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-0033
Mailing Address - Country:US
Mailing Address - Phone:770-236-9355
Mailing Address - Fax:770-236-9357
Practice Address - Street 1:802 DACULA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3324
Practice Address - Country:US
Practice Address - Phone:770-236-9355
Practice Address - Fax:770-236-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty