Provider Demographics
NPI:1285145177
Name:RUSSELL CHIROPRACTIC & ACUPUNCTURE, INC
Entity type:Organization
Organization Name:RUSSELL CHIROPRACTIC & ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-573-1505
Mailing Address - Street 1:10793 TIERRASANTA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10793 TIERRASANTA BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2629
Practice Address - Country:US
Practice Address - Phone:858-573-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29891111N00000X
CAAC11156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty