Provider Demographics
NPI:1942321526
Name:CAMPBELL, GARY DEAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:10158 S PARKER RD
Mailing Address - Street 2:STE B
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-9801
Mailing Address - Country:US
Mailing Address - Phone:303-840-5090
Mailing Address - Fax:303-840-5015
Practice Address - Street 1:10158 S PARKER RD
Practice Address - Street 2:STE B
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-9801
Practice Address - Country:US
Practice Address - Phone:303-840-5090
Practice Address - Fax:303-840-5015
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO4047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44303Medicare UPIN