Provider Demographics
NPI:1770123689
Name:CAMPBELL, CASEY (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
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:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:866-313-3397
Practice Address - Street 1:2630 77TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3085
Practice Address - Country:US
Practice Address - Phone:206-946-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008134111N00000X
CADC36135111N00000X
TX15193111N00000X, 111NR0400X
WACH61489169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC36135OtherCHIROPRACTIC LICENSE
WACH61489169OtherCHIROPRACTIC LICENSE
TX15193OtherCHIROPRACTIC LICENSE