Healthcare Provider Details

I. General information

NPI: 1922088350
Provider Name (Legal Business Name): WILLIAM JOSEPH CAMPAGNOLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W BAY AVE SUITE E
BARNEGAT NJ
08005-2150
US

IV. Provider business mailing address

890 W BAY AVE SUITE E
BARNEGAT NJ
08005-2150
US

V. Phone/Fax

Practice location:
  • Phone: 609-698-5550
  • Fax: 609-698-3031
Mailing address:
  • Phone: 609-698-5550
  • Fax: 609-698-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00291800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: