Healthcare Provider Details

I. General information

NPI: 1578150686
Provider Name (Legal Business Name): DR. JESSICA CAMPLESE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOWER OFFICE PARK STE U
WOBURN MA
01801-2127
US

IV. Provider business mailing address

100 TOWER OFFICE PARK STE U
WOBURN MA
01801-2127
US

V. Phone/Fax

Practice location:
  • Phone: 781-608-5196
  • Fax:
Mailing address:
  • Phone: 781-608-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CAMPLESE
Title or Position: OWNER
Credential: DC
Phone: 781-608-5196