Healthcare Provider Details

I. General information

NPI: 1922648740
Provider Name (Legal Business Name): DCAMPBELL UCCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E ST
WASCO CA
93280-1918
US

IV. Provider business mailing address

620 E ST
WASCO CA
93280-1918
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-5131
  • Fax:
Mailing address:
  • Phone: 661-758-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS L CAMPBELL
Title or Position: PRESIDENT/TREASURER
Credential: DC
Phone: 661-758-5131