Provider Demographics
NPI:1902280282
Name:CAMPOS, LUIZ EDUARDO X (DC)
Entity Type:Individual
Prefix:
First Name:LUIZ
Middle Name:EDUARDO
Last Name:CAMPOS
Suffix:X
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUNTAIN CHASE
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6517
Mailing Address - Country:US
Mailing Address - Phone:864-921-6494
Mailing Address - Fax:
Practice Address - Street 1:3 MOUNTAIN CHASE
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-6517
Practice Address - Country:US
Practice Address - Phone:864-921-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor