Provider Demographics
NPI:1740281476
Name:CAMPBELL, KEVIN JON (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JON
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 1:1853 GLEN ELLEN RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-5449
Mailing Address - Country:US
Mailing Address - Phone:712-274-9812
Mailing Address - Fax:605-232-5255
Practice Address - Street 1:118 GATEWAY DR.
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-1427
Practice Address - Country:US
Practice Address - Phone:605-232-3833
Practice Address - Fax:605-232-5255
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025022600Medicaid
IA2916775Medicaid
SD7604054Medicaid
SD4421Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IA2916775Medicaid