MEDICARE: DR. JOSEPH CAMPOBASSO, P.C.

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		IL

General Provider Information

NPI Number	:	1528260742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JOSEPH CAMPOBASSO, P.C.

Provider Business Mailing Address
First Line	:	1816 ARBOR GATE DR
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-5734
Country	:	US
Telephone Number	:	815-254-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 E DIVISION ST
Second Line	:
City	:	DIAMOND
State	:	IL
Zip	:	60416-9760
Country	:	US
Telephone Number	:	815-634-0755
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH M CAMPOBASSO
Credential	:	D.C.
Telephone Number	:	815-254-8222

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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