Healthcare Provider Details

I. General information

NPI: 1275600256
Provider Name (Legal Business Name): RUSSELL S CAMPANELLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4138 W HENRIETTA RD
ROCHESTER NY
14623-5224
US

IV. Provider business mailing address

3313 CHILI AVE STE D
ROCHESTER NY
14624-5300
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-4060
  • Fax: 585-321-1329
Mailing address:
  • Phone: 585-334-4060
  • Fax: 585-321-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: