Provider Demographics
NPI:1770527210
Name:CAMPBELL, THOMAS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-0070
Mailing Address - Country:US
Mailing Address - Phone:253-537-0266
Mailing Address - Fax:253-537-2579
Practice Address - Street 1:17416 PACIFIC AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8263
Practice Address - Country:US
Practice Address - Phone:253-537-0266
Practice Address - Fax:253-537-2579
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350027898OtherRAILROAD MEDICARE
WACA1297OtherREGENCE BLUESHIELD OF WA
WA2052207Medicaid
WA24691OtherLABOR AND INDUSTRIES
WA350027898OtherRAILROAD MEDICARE
WATO2674Medicare UPIN