Healthcare Provider Details

I. General information

NPI: 1184660383
Provider Name (Legal Business Name): COREY JOSEPH CAMPBELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COREY JOSEPH CAMPBELL

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5335
US

IV. Provider business mailing address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5335
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-0404
  • Fax: 402-496-0517
Mailing address:
  • Phone: 402-496-0404
  • Fax: 402-496-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1328
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: