Provider Demographics
NPI:1962484238
Name:CAMPBELL, DONALD B (DCPA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:B
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 SOUTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1923
Mailing Address - Country:US
Mailing Address - Phone:904-725-2286
Mailing Address - Fax:904-725-4566
Practice Address - Street 1:1639 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1923
Practice Address - Country:US
Practice Address - Phone:904-725-2286
Practice Address - Fax:904-725-4566
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88925YMedicare PIN