Healthcare Provider Details

I. General information

NPI: 1366651986
Provider Name (Legal Business Name): RUSSELL D SEAGAL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S FLOWER ST SUITE 204
LOS ANGELES CA
90017-4625
US

IV. Provider business mailing address

26733 OAK GARDEN CT
NEWHALL CA
91321-1434
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7026
  • Fax: 213-623-9985
Mailing address:
  • Phone: 818-681-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number19979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: