Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 821 | OH |
NPI | 1174655849 |
---|---|
Provider Name | Dr. Dale Eugene Campbell |
First Address | Ashland, OH 44805-4314 |
Second Address | Wooster, OH 44691-1734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0430046 | (05) | OH |