Individual
MR. SHANNON D CAMPBELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
1114 9TH AVE, LEWISTON, ID 83501-2659
(208) 748-3102
Mailing address
330 N GRANT ST, MOSCOW, ID 83843-3674
(208) 882-3239
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-067
ID
Other
Enumeration date
03/22/2006
Last updated
07/08/2007
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