Provider Demographics
NPI:1861957789
Name:CAMPBELL, DAVID MICHAEL (DSOM, LAC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E COEUR D ALENE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2873
Mailing Address - Country:US
Mailing Address - Phone:208-643-2490
Mailing Address - Fax:
Practice Address - Street 1:520 E COEUR D ALENE AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2873
Practice Address - Country:US
Practice Address - Phone:208-643-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61172209171100000X
ORAC190542171100000X
IDACU-436171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist