Provider Demographics
NPI:1427109529
Name:CAMPANARO, GARY JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:CAMPANARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1698 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-4977
Mailing Address - Country:US
Mailing Address - Phone:831-443-6908
Mailing Address - Fax:831-393-2411
Practice Address - Street 1:800 PORTOLA DR
Practice Address - Street 2:STE B
Practice Address - City:DEL REY OAKS
Practice Address - State:CA
Practice Address - Zip Code:93940-5530
Practice Address - Country:US
Practice Address - Phone:831-393-2221
Practice Address - Fax:831-393-2411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU84759Medicare UPIN
CADC0205370Medicare ID - Type Unspecified