Provider Demographics
NPI:1528260742
Name:DR. JOSEPH CAMPOBASSO, P.C.
Entity type:Organization
Organization Name:DR. JOSEPH CAMPOBASSO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMPOBASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-254-8222
Mailing Address - Street 1:1816 ARBOR GATE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5734
Mailing Address - Country:US
Mailing Address - Phone:815-254-8222
Mailing Address - Fax:
Practice Address - Street 1:2425 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:IL
Practice Address - Zip Code:60416-9760
Practice Address - Country:US
Practice Address - Phone:815-634-0755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU78339Medicare UPIN