Healthcare Provider Details

I. General information

NPI: 1649549619
Provider Name (Legal Business Name): RUSSELL J. DUNLOP D. C. P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W END AVE
SOMERVILLE NJ
08876-1816
US

IV. Provider business mailing address

146 WEST END AVE.
SOMERVILLE NJ
08876-1816
US

V. Phone/Fax

Practice location:
  • Phone: 908-526-2883
  • Fax: 908-526-2885
Mailing address:
  • Phone: 908-526-2883
  • Fax: 908-526-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00150700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00025500
License Number StateNJ

VIII. Authorized Official

Name: DR. RUSSELL JAMES DUNLOP
Title or Position: PRESIDENT
Credential: D.C. LAC
Phone: 908-526-2883