Healthcare Provider Details

I. General information

NPI: 1740484443
Provider Name (Legal Business Name): RUSSELL AND ROSS CHIROPRACTIC CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SUNRISE AVE SUITE 115
ROSEVILLE CA
95661-4500
US

IV. Provider business mailing address

755 SUNRISE AVE SUITE 115
ROSEVILLE CA
95661-4500
US

V. Phone/Fax

Practice location:
  • Phone: 916-786-6055
  • Fax: 916-786-6452
Mailing address:
  • Phone: 916-786-6055
  • Fax: 916-786-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24580
License Number StateCA

VIII. Authorized Official

Name: DR. ALLAN S. ROSS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 916-786-6055