Provider Demographics
NPI:1720074214
Name:CAMPO, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:CAMPO
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 1:700 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1240
Mailing Address - Country:US
Mailing Address - Phone:631-732-1386
Mailing Address - Fax:631-732-1544
Practice Address - Street 1:700 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1240
Practice Address - Country:US
Practice Address - Phone:631-732-1386
Practice Address - Fax:631-732-1544
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73359Medicare UPIN
X4B631Medicare ID - Type Unspecified