Provider Demographics
NPI:1194536649
Name:RUSSO, WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:695 HOPEWELL DR UNIT 4202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7183
Mailing Address - Country:US
Mailing Address - Phone:401-284-6410
Mailing Address - Fax:
Practice Address - Street 1:903 SAINT ANDREWS BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7194
Practice Address - Country:US
Practice Address - Phone:843-225-4357
Practice Address - Fax:843-225-4379
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor