MEDICARE: JOHN JOSEPH CAMPAGNA DC

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	111N00000X	Chiropractor	X006160-1	NY

General Provider Information

NPI Number	:	1548394927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH CAMPAGNA DC

Provider Business Mailing Address
First Line	:	9138 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1929
Country	:	US
Telephone Number	:	716-633-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	9138 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1929
Country	:	US
Telephone Number	:	716-633-6161
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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