Provider Demographics
NPI:1700989746
Name:CAMPBELL, MICHAEL MCKEOUGH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MCKEOUGH
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 1:383 E LAGOON ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3017
Mailing Address - Country:US
Mailing Address - Phone:435-722-3370
Mailing Address - Fax:435-722-3384
Practice Address - Street 1:383 E LAGOON ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3017
Practice Address - Country:US
Practice Address - Phone:435-722-3370
Practice Address - Fax:435-722-3384
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8526112-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor