Provider Demographics
NPI:1801956917
Name:CAMPBELL, MATTHEW JAY (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
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 1:19009 33RD AVENUE WEST
Mailing Address - Street 2:205
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-776-8787
Mailing Address - Fax:425-776-1349
Practice Address - Street 1:19009 33RD AVE W
Practice Address - Street 2:205
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4717
Practice Address - Country:US
Practice Address - Phone:425-776-8787
Practice Address - Fax:425-776-1349
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0002411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA58889OtherLABOR & INDUSTRY
WAU11466Medicare UPIN
WA001201401Medicare ID - Type Unspecified