Individual provider Active NPI

Brad Campbell, D.C.

  • Chiropractor
  • Wilmette, IL
National Provider Identifier
1043666076
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038012966 Issued in IL
Practice address
522 Poplar Dr
Wilmette, IL 60091-2717
Phone
(847) 251-0044
Fax
(847) 251-0066
NPI assigned
May 9, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038012966 IL Primary

Addresses

Primary practice location

522 Poplar Dr
Wilmette, IL 60091-2717

Mailing address

522 Poplar Dr
Wilmette, IL 60091-2717
Phone (847) 251-0044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160624001325 IL Practitioner - Chiropractic 5395034987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Holistic Healthcare, S.C. Chiropractor CurrentSince Jun 10, 2016 Accepting new patients
Halcyon Health Chiropractic, S.C. Chiropractor PastSince Jun 10, 2016 Accepting new patients

Locations

522 Poplar Dr
Wilmette, IL 60091
Phone (847) 251-0044

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1043666076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 POPLAR DR",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912717",
            "telephone_number": "847-251-0044",
            "fax_number": "847-251-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 POPLAR DR",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912717",
            "telephone_number": "847-251-0044",
            "fax_number": "847-251-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "BRAD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmette, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.