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General NPI Number Information
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NPI Number | 1528197506
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Entity Type | Individual
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Provider Name | KENNETH JOHN CAMPO D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16 E 40TH ST SUITE 1004
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City | NEW YORK
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State | NY
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Zip | 10016-0113
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Country | US
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Telephone | 212-308-6298
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Fax | 718-236-0141
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Provider Business Mailing Address
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Address Line | 16 E 40TH ST SUITE 1004
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City | NEW YORK
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State | NY
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Zip | 10016-0113
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Country | US
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Telephone | 212-308-6298
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Fax | 718-236-0141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X8626
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License Number State | NY
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