Provider Demographics
NPI:1205984747
Name:CAMPANELLA, NICHOLAS (DC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:CAMPANELLA
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 1:4A NORTH AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-893-8339
Mailing Address - Fax:410-838-8011
Practice Address - Street 1:4A NORTH AVE
Practice Address - Street 2:STE 207
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-893-8339
Practice Address - Fax:410-838-8011
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor