Provider Demographics
NPI:1831269117
Name:CAMPBELL, JOHN DONALD (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DONALD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-2069
Mailing Address - Country:US
Mailing Address - Phone:508-693-4042
Mailing Address - Fax:508-696-7256
Practice Address - Street 1:2 RYANS WAY
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-1237
Practice Address - Country:US
Practice Address - Phone:508-693-4042
Practice Address - Fax:508-696-7256
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACAY35122OtherBLUE CROSS BLUE SHIELD
MA35889OtherHARVARD PILGRIM
MAY3512201Medicare Oscar/Certification
MA35889OtherHARVARD PILGRIM