Provider Demographics
NPI:1124242821
Name:RUSSELL, MICHAEL DENNIS (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENNIS
Last Name:RUSSELL
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 1:1164 MONROE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3565
Mailing Address - Country:US
Mailing Address - Phone:831-443-1222
Mailing Address - Fax:831-443-0732
Practice Address - Street 1:1164 MONROE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3565
Practice Address - Country:US
Practice Address - Phone:831-443-1222
Practice Address - Fax:831-443-0732
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor