Provider Demographics
NPI:1942386743
Name:CAMPBELL, CHRIS S (DC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:S
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 1:1470 GEORGE DIETER DR
Mailing Address - Street 2:STE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7631
Mailing Address - Country:US
Mailing Address - Phone:915-857-7518
Mailing Address - Fax:915-857-7518
Practice Address - Street 1:1470 GEORGE DIETER
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-857-7518
Practice Address - Fax:915-857-7518
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6011869OtherAETNA
0471649OtherCIGNA
TX089950FOtherBCBS
TX001383101Medicaid
TX6011869Medicare PIN
TX089950FOtherBCBS
TX601869Medicare ID - Type Unspecified