MEDICARE: DR. JACOB ROBERT CAMPBELL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	112065	IA

General Provider Information

NPI Number	:	1205595766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB ROBERT CAMPBELL DC

Provider Business Mailing Address
First Line	:	116 BRICK ST SE
Second Line	:
City	:	BONDURANT
State	:	IA
Zip	:	50035-2125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 S 68TH ST STE 1206
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8176
Country	:	US
Telephone Number	:	515-494-6554
Fax Number	:	515-414-7722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	01/12/2026

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