Provider Demographics
NPI:1912030149
Name:M JAY CAMPBELL D C P S
Entity Type:Organization
Organization Name:M JAY CAMPBELL D C P S
Other - Org Name:PARKSIDE SPINE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-776-8787
Mailing Address - Street 1:19125 33RD AVE W STE D
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4735
Mailing Address - Country:US
Mailing Address - Phone:425-776-8787
Mailing Address - Fax:425-776-1349
Practice Address - Street 1:19125 33RD AVE W STE D
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4735
Practice Address - Country:US
Practice Address - Phone:425-776-8787
Practice Address - Fax:425-776-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA58889OtherLABOR & INDUSTRIES
WAU11466Medicare UPIN