Provider Demographics
NPI:1770783912
Name:KINGWOOD CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:KINGWOOD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:281-358-7777
Mailing Address - Street 1:1434 KINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3040
Mailing Address - Country:US
Mailing Address - Phone:281-358-7777
Mailing Address - Fax:281-358-8780
Practice Address - Street 1:1434 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3040
Practice Address - Country:US
Practice Address - Phone:281-358-7777
Practice Address - Fax:281-358-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83V121OtherBCBS PROVIDER #
TX83V121OtherBCBS PROVIDER #