Provider Demographics
NPI:1447898978
Name:CAMPBELL, JILLIAN (DC)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:CAMPBELL
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 1:6504 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1071
Mailing Address - Country:US
Mailing Address - Phone:757-232-7586
Mailing Address - Fax:
Practice Address - Street 1:30 W GUDE DR STE 375
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4300
Practice Address - Country:US
Practice Address - Phone:301-545-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030212111N00000X
VA0104557622111N00000X
MDS04044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor