1811355357 NPI number — JENNIFER CAMPAGNA CHIROPRACTIC CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811355357 NPI number — JENNIFER CAMPAGNA CHIROPRACTIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER CAMPAGNA CHIROPRACTIC CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811355357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17411 BEACH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92647-5948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-596-2260
Provider Business Mailing Address Fax Number:
714-596-2290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17411 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92647-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-596-2260
Provider Business Practice Location Address Fax Number:
714-596-2290
Provider Enumeration Date:
01/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPAGNA
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
714-596-2260

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC28774 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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