=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417268640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANYON CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 06/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4303 W 27TH AVE STE E
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99338-1986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-834-8960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4303 W 27TH AVE STE E
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99338-1986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-834-8960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. BRANDON PAUL CAMPBELL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 509-834-8960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | CH00034828
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------