Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.011405 | IL |
NPI | 1003041153 |
---|---|
Provider Name | Dr. Jorge Alberto Campos |
First Address | Davenport, IA 52803-5324 |
Second Address | Moline, IL 61265-5240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 19/05/2009 |