Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 165972-1202 | UT |
NPI | 1013023282 |
---|---|
Provider Name | Craig D Campbell |
First Address | Midvale, UT 84047-1533 |
Second Address | Midvale, UT 84047-1533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 23/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48896 | (02) | UT |