Provider Demographics
NPI:1205996220
Name:CAMPBELL, THOMAS J (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
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Mailing Address - Street 1:2616 SHERWOOD HALL LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-619-1002
Mailing Address - Fax:703-619-1340
Practice Address - Street 1:2616 SHERWOOD HALL LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-619-1002
Practice Address - Fax:703-619-1340
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0104556180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF629-0002OtherPIN NUMER CARE FIRST BCBS
VA183857OtherPIN NUMBER ANTHEM BCBS
VAF629-0002OtherPIN NUMER CARE FIRST BCBS