Healthcare Provider Details

I. General information

NPI: 1801947585
Provider Name (Legal Business Name): LEROY CURTIS RUSSELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 W 3RD ST
MONTGOMERY AL
36106-1506
US

IV. Provider business mailing address

1714 W 3RD ST
MONTGOMERY AL
36106-1506
US

V. Phone/Fax

Practice location:
  • Phone: 334-834-6282
  • Fax: 334-834-6418
Mailing address:
  • Phone: 334-834-6282
  • Fax: 334-834-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1762
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: