Healthcare Provider Details

I. General information

NPI: 1265636336
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH CAMPAGNA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 S FORTUNA BLVD
FORTUNA CA
95540-3034
US

IV. Provider business mailing address

739 S FORTUNA BLVD
FORTUNA CA
95540-3034
US

V. Phone/Fax

Practice location:
  • Phone: 707-682-6155
  • Fax:
Mailing address:
  • Phone: 707-682-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR007533
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC34488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: