Provider Demographics
NPI:1306918859
Name:RUSSO CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:RUSSO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:AHLERT
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:504-289-6981
Mailing Address - Street 1:4033 VETERANS MEMORIAL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5525
Mailing Address - Country:US
Mailing Address - Phone:504-407-0896
Mailing Address - Fax:504-324-5618
Practice Address - Street 1:4033 VETERANS MEMORIAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5525
Practice Address - Country:US
Practice Address - Phone:504-407-0896
Practice Address - Fax:504-324-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty