MEDICARE: DR. DALE EUGENE CAMPBELL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	821	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174655849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE EUGENE CAMPBELL D.C.

Provider Business Mailing Address
First Line	:	343 STEELE AVE
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-4314
Country	:	US
Telephone Number	:	419-281-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1734
Country	:	US
Telephone Number	:	330-345-7188
Fax Number	:	330-345-4334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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