Provider Demographics
NPI:1124070917
Name:WEBB, RUSSELL ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ADAM
Last Name:WEBB
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:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-1307
Mailing Address - Country:US
Mailing Address - Phone:520-568-5437
Mailing Address - Fax:480-857-2506
Practice Address - Street 1:19428 N MARICOPA RD
Practice Address - Street 2:SUITE C1
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239
Practice Address - Country:US
Practice Address - Phone:520-568-5437
Practice Address - Fax:480-857-2506
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor