Provider Demographics
NPI:1104934975
Name:TEMPLETON, RUSSELL DALE (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DALE
Last Name:TEMPLETON
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 1:1415 GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792
Mailing Address - Country:US
Mailing Address - Phone:828-698-0102
Mailing Address - Fax:828-698-0639
Practice Address - Street 1:1415 GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792
Practice Address - Country:US
Practice Address - Phone:828-698-0102
Practice Address - Fax:828-698-0639
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08834OtherNC STATE HEALTH PLAN
NC7908834Medicaid
NC08834OtherBC OF NC
NC08834OtherBC OF NC
U54000Medicare UPIN