Healthcare Provider Details

I. General information

NPI: 1629855168
Provider Name (Legal Business Name): PORTLAND DISC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CITY CENTER FIRST FLOOR
PORTLAND ME
04101
US

IV. Provider business mailing address

PO BOX 10425
PORTLAND ME
04104-0425
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-2622
  • Fax: 207-699-2624
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT CAMPBELL III
Title or Position: MEMBER
Credential: DC, DACNB
Phone: 207-699-2622