Provider Demographics
NPI:1366258329
Name:CAMPBELL CHIROPRACTIC AND REHABILITATION
Entity type:Organization
Organization Name:CAMPBELL CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-320-1503
Mailing Address - Street 1:3524 S WICKENS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4514
Mailing Address - Country:US
Mailing Address - Phone:812-320-1503
Mailing Address - Fax:
Practice Address - Street 1:3880 E 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5526
Practice Address - Country:US
Practice Address - Phone:812-320-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty