Provider Demographics
NPI:1366428138
Name:CAMPBELL, DAVID (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:901 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3171
Mailing Address - Country:US
Mailing Address - Phone:843-549-6729
Mailing Address - Fax:843-549-2246
Practice Address - Street 1:901 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3171
Practice Address - Country:US
Practice Address - Phone:843-549-6729
Practice Address - Fax:843-549-2246
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2662Medicaid
SCU90590Medicare UPIN