Provider Demographics
NPI:1447455340
Name:CAMPISE, JOHN B (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CAMPISE
Suffix:
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 1:5035 E BELMONT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2459
Mailing Address - Country:US
Mailing Address - Phone:559-454-1154
Mailing Address - Fax:
Practice Address - Street 1:5035 E BELMONT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-2459
Practice Address - Country:US
Practice Address - Phone:559-454-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27590OtherCALIFORNIA CHIRO LISCENSE
CADC27590OtherCALIFORNIA CHIRO LISCENSE