Provider Demographics
NPI:1730191677
Name:CAMPBELL BOLDUC, ZOHRA (DC)
Entity type:Individual
Prefix:DR
First Name:ZOHRA
Middle Name:
Last Name:CAMPBELL BOLDUC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4584
Mailing Address - Country:US
Mailing Address - Phone:503-371-1120
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:3276 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4584
Practice Address - Country:US
Practice Address - Phone:503-371-1120
Practice Address - Fax:503-391-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142695Medicare PIN